When I first entered in a hand surgery operation theater, I was a young medical student, and the famous plastic surgeon of the hospital was operating on a hand with contracted fingers. I saw and understood almost nothing, and I could not imagine how it was possible to find those small little structures, the nerves and arteries in that hard tissue block without hurting them. After this first admiration immediately came a great disappointment: the operation was finished with a big open wound in the palm, without even attempting to close it. I remember thinking that I would definitely not be happy to have this in my own palm. That time I was not even thinking of becoming a hand surgeon, but life sometimes takes interesting turns. I have seen myself travelling from a politically isolated Eastern European country to be a resident in Stockholm’s Karolinska Institute and to Guy Foucher’s SOS Main Strasbourg Clinique, followed by years in Nice University Hospital and in Showa University in Tokyo. I have learned a lot. I have learned how to do things and how not to do things. It was difficult to accept, but I have seen that what was white in one part of the world was black on the other side with different grays in the middle. In 1997 in Bologna, during my oral examination for the European Diploma Examination, Professor Safar asked me about the operation of a Dupuytren-contracted PIP joint, about the relations of the Grayson and Cleland ligaments, and about the importance of the spiral cord and what to do with the checkreins. If I would like to summarize my opinion of the first 10 years of hand surgery concerning Dupuytren Disease, I would say that this is one of the most exciting conditions of the hand solved in different manners, with different skills and techniques. If I would like to make a quick opinion on a hand surgeon’s skills, this would be the first operation I would like to see him perform.

As the scientific chairman of the 2004 Budapest IFSSH Congress, I noticed that hand surgeons like Dupuytren Disease. There were many abstracts for free papers and a large number of attendance in the lecture rooms. Dupuytren is just like football and politics: everyone is an expert. In the last decades, there was great interest but no historical discoveries, no revolutionary changes, and no unsolvable controversies. Dupuytren Disease was a calm sea in the middle of the ocean of hand surgery. There were some basic research articles dealing with the histopathology of the disease but without great interest for the everyday practitioner. When I became chairman of the European Diploma Examination, it became clear during the evaluation of the examination results that Dupuytren Disease is one of the favorite topics of the candidates. That was the perfect question when the examiner wanted to help the candidate.

When a group of European hand surgeons from different countries and different strategic positions were invited by a medical drug company (Pfizer) for a whole day brainstorming session and the subject of the discussion was an injection which would solve the contracture and replace surgery, nobody thought that this event/drug would definitively change our view and knowledge on Dupuytren Disease. Dozens of serious concerns were listed, and a significant opposition was detected against the original material, method, and outcome prognosis. The surprising outcome of this meeting was that for the first time in the history of hand surgery, a medical drug company was interested in the opinions of the specialists and, even more importantly, took them seriously. An advisory board was formed and our initial concerns were taken in consideration. New and more detailed data on the drug was provided. Instructional materials were replaced. The importance of training was accepted. Authorization to use the drug was restricted to medical staff that had experience in the treatment of the disease. Clinical studies were considered and started. However, the real value of the collagenase injection was that starting with its commercial introduction, in almost all major hand surgical events, FESSH and IFSSH congresses, national congresses, and courses, a symposium or a workshop or a session dealing with Dupuytren Diseases was included. The good thing was that these sessions not only dealt with the “new” treatment method but also relaunched the research on the etiology on the different treatment methods, on the outcomes, and on the recurrences of the disease. We should not underestimate the financial contribution of the drug-selling company to the budget of these scientific events directly contributing to the teaching value of these events and the positive influence on basic and clinical research sponsored by them. Due to this, Dupuytren Disease became in the focus of every organization dealing with hand surgery, and every hand surgeon wanted to have information on this new treatment method.