J Korean Orthop Assoc.  2019 Aug;54(4):353-360. 10.4055/jkoa.2019.54.4.353.

Clinical Results of Subtotal Fasciectomy for Treatment of Dupuytren Contracture

• Lee YM
• Song SW
• Kim YW
• Choi JH

• KMID: 2455504
• DOI: http://doi.org/10.4055/jkoa.2019.54.4.353

Abstract

PURPOSE
In the treatment of Dupuytren's contracture, the aim of optical treatment is to lower the recurrence rate and reduce complications. This paper reports the results of subtotal fasciectomy in Dupuytren's contracture, extending the excision of palmar fascial structures from the diseased to normal appearing adjacent fascial structure.
MATERIALS AND METHODS
From 2007 to 2017, 45 patients with Dupuytren's contracture treated by subtotal fasciectomy were reviewed retrospectively. The mean follow-up period was 45.9 months. Ninety-two digits were involved (index: 2, middle: 10, ring: 44, little: 36). The predisposing factors and affected joint were reviewed and the preoperative and postoperative contracture was measured. For clinical results, quick disabilities of the arm, shoulder, and hand (quick DASH) were used. Complications, including wound or skin problems, nerve injuries, hematoma, and complex regional pain syndrome, were assessed.
RESULTS
Preoperative flexion contracture was 43.2° in the proximal interphalangeal joint and 32.9° in the metacarpophalangeal joint. In nine cases, patients had residual contracture of 9.7° (range, 5°-20°) on average and if the total number of cases were included, the mean residual contracture was 2.3° on average. The quick DASH score at the 12 months follow-up was 12.4. The overall complication rate was 26.6%.
CONCLUSION
Subtotal fasciectomy can be a good surgical treatment option for Dupuytren's contracture with a low recurrence and low complication rate compared to other open procedures.

Keyword

Dupuytren's contracture; subtotal fasciectomy; prevention of recurrence; low complication rate

MeSH Terms

Arm
Causality
Contracture
Dupuytren Contracture*
Follow-Up Studies
Hand
Hematoma
Humans
Joints
Metacarpophalangeal Joint
Recurrence
Retrospective Studies
Shoulder
Skin
Wounds and Injuries

Figure

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  Figure 1 Surgical techniques. (A) McFarlane skin incision for the case with multiple digits. (B) Simple zig-zag skin incision for the case with a single digit. (C) Nodules and cords were exposed after the dissection of subcutaneous fat tissues. (D) After the excision of diseased nodules and cords saving the neurovascular bundle, normal tendon and pulley were exposed. (E) Contracted joint was released to the neutral position after subtotal fasciectomy.

• 

  Figure 2 (A) Tubiana grade IV contracture at the right little finger. (B) After dissection, pretendinous, spiral and central cord were identified. (C) After subtotal fasciectomy, the contracted finger was release into the neutral position.

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  Figure 3 A 73-year-old male patient with Dupuytren's contracture in both hands. (A) In the left hand, dehiscence occurred at the surgical wound after stich-out. (B) After 3 weeks of regular wound dressing, the wound healed without a skin graft.

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