Indications of the Continuous Extension Technique (TEC) for Severe Dupuytren Disease and Recurrences

Chapter

Abstract

The continuous extension technique (TEC) is a device that can be used for treating finger(s) that are severely contracted due to progressive Dupuytren disease. TEC methodology is an alternative to amputation. The TEC device is an external fixation system able to extend the retracted digito-palmar aponeurosis, the skin and soft tissues of the finger(s) back to as they were at the first stage of the disease. The continuous minimally traumatic and painless lengthening of the skin and fascia produces a regenerative action on the retracted skin and ligaments of digital joints. After its positioning, a 2 mm continuous extension is performed daily by the patient himself for 3 weeks. At the end of the treatment, the finger and its structures are completely extended, the device is removed and at the same time a simple fasciectomy is performed, if necessary.

We have treated 130 patients; 86 were reviewed with a mean follow-up of 4 years (8 months to 10 years).

Excellent and good results in 85 % of cases (finger(s) extended up to the first stage of the disease), fair in 15 % and no poor result. No finger required amputation. Sixteen percent reported stiffness and 18 % recurrence or extension (8 % recurrence and 10 % extension) of the disease. The residual joint stiffness was restored in up to 6 weeks by hand therapy; no secondary surgery was performed, and no skin plastic operations were necessary. At the end of the continuous extension, all treated fingers acquired very good microvascularity of the skin and of fingers together with a better trophic and discriminative sensibility.

This procedure is simple and can be used also for any retracted finger as an alternative to amputation (in Dupuytren disease or after contracture due to bone and tendon trauma or burns). The gradual extension leads to regeneration of the contracted fibrous tissue. It is not traumatic and painless for the patient. The subsequent fasciectomy of the elongated digito-palmar fascia is a straightforward surgical procedure.

Keywords

Recurrence Continuous extension technique Treatment of Dupuytren disease Morphology of Dupuytren Pathobiochemistry of Dupuytren Indication procedures for Dupuytren disease Soft tissue mechanical stress 

Notes

Conflict of Interest Declaration

The authors have no conflict of interest to declare.

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Hand Surgery Unity of G. Pini Ortopaedic Institut of MilanMilanItaly
  2. 2.Hand Surgery Center, Clinica Fornaca di SessantRivoli, TurinItaly

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