Most naturally, surgical resection of all macroscopically affected contracting tissue in Dupuytren Disease, including overlying skin, is extensive surgery. The challenge is an anatomical dissection of the hand, wherein neurovascular bundles need to be isolated from the fibroproliferative tissue and tendons; pulleys, joints and capsul need to be kept intact. In fact, usually, the palmar preaxial part of the finger is removed leaving a large wound behind, which was the inspiration to name the Hueston technique a subtotal preaxial amputation. Certainly, if the grafting is preferred for reasons of non-recurrence underneath the grafts and firebreak effects, more extensive grafting may be required to maximise Dupuytren-free areas.

In our department, full-thickness grafting has been performed for over 15 years in Dupuytren Disease. However, it was mostly considered in case of severe contractures with skin shortage or severe recurrent disease (47 % had previous surgery with recurrent contractures). We prefer medial forearm skin as donor site providing abundance, hair-free skin and causing hardly any morbidity (Fig. 40.2). Recently, patients were invited for review to evaluate long-term follow-up to assess recurrence or extension of Dupuytren Disease after skin grafting. In a group of 47 patients with a 3–16-year follow-up, not one recurrent nodule or cord was noted underneath the full-thickness skin grafts. However, extension of the disease in adjacent areas was seen in over 4 in 5 patients. Most of these patients with disease extension had a high fibrosis diathesis (detailed report under review) as there was a significantly higher score of Abe for Dupuytren diathesis in the recurrent (extended) group of over 4, where it was under 4 in the group without evidence for recurrent disease and/or contractures (Abe et al. 2004).

On the other hand, during the last three decades, all reports on full-thickness grafting have been promising. Presumably it is the extensiveness of the procedure and the vast recovery period that prevent patients and surgeons from choosing this procedure as the first standard in most hand practices.

In 1992, Kelly and Varian saw 2 recurrences in 24 patients, but extension of the disease was seen in almost half of them (Kelly and Varian 1992). In the same year, Searle and Logan observed minimal nodule formation at the graft edges in 4 of 32 patients after 2 years (Searle and Logan 1992). Brotherston et al. saw no recurrence in 34 patients after 5–8-year follow-up (Brotherston et al. 1994). Hall reported 8 % recurrence in 67 patients in 2–7-year follow-up (Hall et al. 1997). Armstrong reported on a low recurrence rate of 11 % in a series of 103 patients after almost 6 years of follow-up (Armstrong et al. 2000). In 2009, Chen et al. again reported no recurrence in 68 patients with full-thickness grafting in contrast to 46 % recurrence in partial fasciectomy (Chen et al. 2009).