Abstract
Background
Numerous options exist for the treatment of Dupuytren’s contracture. This study describes the technique and early results of partial fasciectomy through a mini-incision approach as an additional treatment option for Dupuytren’s disease.
Methods
This procedure involves the excision of diseased Dupuytren’s tissue with the use of multiple 1 cm transverse incisions. Patient demographics, digit involvement, the number of incisions required to release each digit, and complications were recorded for all patients. Range of motion data was obtained from a subgroup of patients that had at least 6 months of follow-up. A paired t test was used to compare preoperative and postoperative contracture.
Results
Sixty-seven patients underwent 75 procedures that involved 119 digits. The mean patient age at the time of surgery was 63 years (range, 33–95 years). A total of 32 digits (47 joints) were available for range of motion analysis. After a mean of 2.2 years following surgery, metacarpophalangeal joint contractures maintained correction (34° preoperatively, 19° postoperatively, p = 0.008). After a mean postoperative duration of 2.0 years, proximal interphalangeal joint contractures trended worse than preoperative levels (39° preoperatively, 45° postoperatively, p = 0.319). There was one major complication, which consisted of a nerve laceration that was identified and repaired intraoperatively.
Conclusions
Partial fasciectomy through the described mini-incision approach provides an additional surgical option for patients who desire a less invasive surgical procedure than traditional fascietomy. Although this procedure is safe and effective at achieving immediate cord release, maintenance of correction for proximal interphalangeal joint contractures remains problematic.
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References
Anwar MU, Al Ghazal SK, Boome RS. Results of surgical treatment of Dupuytren’s disease in women: a review of 109 consecutive patients. J Hand Surg Am. 2007;32:1423–8.
Badalamente MA, Hurst LC. Enzyme injection as nonsurgical treatment of Dupuytren’s disease. J Hand Surg Am. 2000;25:629–36.
Badalamente MA, Hurst LC. Efficacy and safety of injectable mixed collagenase subtypes in the treatment of Dupuytren’s contracture. J Hand Surg Am. 2007;32:767–74.
Badalamente MA, Hurst LC, Hentz VR. Collagen as a clinical target: nonoperative treatment of Dupuytren’s disease. J Hand Surg Am. 2002;27:788–98.
Brandt KE. An evidence-based approach to Dupuytren’s contracture. Plast Reconstr Surg. 2010;126:2210–5.
Citron N, Hearnden A. Skin tension in the aetiology of Dupuytren’s disease: a prospective trial. J Hand Surg Br. 2003;28:528–30.
Coert JH, Nérin JP, Meek MF. Results of partial fasciectomy for Dupuytren disease in 261 consecutive patients. Ann Plast Surg. 2006;57:13–7.
Eaton C. Percutaneous fasciotomy for Dupuytren’s contracture. J Hand Surg Am. 2011;36:910–5.
Gilpin D, Coleman S, Hall S, et al. Injectable collagenase Clostridium histolyticum: a new nonsurgical treatment for Dupuytrens disease. J Hand Surg Am. 2010;35:2027–38.
Hueston JT. Dermatofasciectomy for Dupuytren’s disease. Bull Hosp Jt Dis Orthop Inst. 1984;44:224–32.
Hurst LC, Badalamente MA, Hentz VR, et al. Injectable collagenase Clostridium histolyticum for Dupuytren’s Contracture. N Engl J Med. 2009;361:968–79.
Moermans JP. Segmental aponeurectomy in Dupuytren’s disease. J Hand Surg Br. 1991;16:243–54.
Moermans JP. Long-term results after segmental aponeurectomy for Dupuytren’s disease. J Hand Surg Br. 1996;21:797–800.
Pess GM, Pess RM, Pess RA. Results of needle aponeurotomy for Dupuytren contracture in over 1,000 fingers. J Hand Surg Am. 2012;37:651–6.
Shin EK, Jones NF. Minimally invasive technique for release of Dupuytren’s contracture: segmental fasciectomy through multiple transverse incisions. Hand. 2011;6:256–9.
Srinivasan RC, Shah SH, Jebson PJ. New treatment options for Dupuytren’s surgery: collagenase and percutaneous aponeurotomy. J Hand Surg Am. 2010;35:1362–4.
Tonkin MA, Burke FD, Varian JP. Dupuytren’s contracture: a comparative study of fasciectomy and dermatofasciectomy. J Hand Surgery Br. 1984;9:156–62.
Ullah AS, Dias JJ, Bhowal B. Does a ‘firebreak’ full-thickness skin graft prevent recurrence after surgery for Dupuytren’s contracture?: a prospective, randomised trial. J Bone Joint Surg Br. 2009;91:374–8.
Watt AJ, Curtin CM, Hentz VR. Collagenase injection as nonsurgical treatment of Dupuytren’s disease: 8-year follow-up. J Hand Surg Am. 2010;35:534–9. 539.e1.
Werker PM, Pess GM, van Rijssen AL, Denkler K. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions. J Hand Surg Am. 2012;37(10):2095–2105.e7.
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The authors declare that they have no conflicts of interest, commercial associations, or intent of financial gain regarding this research.
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Gelman, S., Schlenker, R., Bachoura, A. et al. Minimally invasive partial fasciectomy for Dupuytren’s contractures. HAND 7, 364–369 (2012). https://doi.org/10.1007/s11552-012-9461-x
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DOI: https://doi.org/10.1007/s11552-012-9461-x