A clinical report of the effect of mechanical stress on functional results after fasciectomy for dupuytren's contracture

Evans, Roslyn B.; Dell, Paul C.; Fiolkowski, Paul

doi:10.1016/s0894-1130(02)80004-7

Cited by 50 publications

(43 citation statements)

References 72 publications

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“…As shown in other studies that employ splinting techniques similar to ours [9], the incidence of scar hypertrophy and sensitivity were low.…”

Section: Discussionsupporting

confidence: 70%

“…Although this study did not investigate the relationship between splinting the extremity in a relaxed position and its effect on postoperative short-and long-term range of motion, other studies have demonstrated that there is no detriment to these or other functional outcomes [9]. This study is limited by lack of clear and validated outcome tools used to judge flare reaction, scar healing, and Dupuytren-related surgical complications.…”

Section: Discussionmentioning

confidence: 90%

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The Incidence of Postoperative Flare Reaction and Tissue Complications in Dupuytren's Disease Using Tension-Free Immobilization

Rivlin

Osterman

Jacoby

et al. 2014

Hand (New York, N,Y.)

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Purpose Open fasciectomy represents a standard treatment of Dupuytren's disease. Although patients are commonly immobilized in extension to prevent postoperative contracture formation, immobilizing the extremity under tension may precipitate a flare reaction and scar-related complications. This study explores the incidence of flare reaction and other complications with postoperative tension-free splinting after fasciectomy for Dupuytren's contracture. Methods We retrospectively reviewed patients' charts that consisted of 228 procedures in 191 patients who underwent surgery by the senior author between 2000 and 2010. Postoperative notes were reviewed for wound healing problems, scar appearance, flare reaction, and complications. The grading system defined by Evans et al. was used to standardize flare reaction and scar complications. Results Using tension-free splinting, the incidence of flare reaction was 3.5 % (8/228). The eight patients that had flare reactions had mild involvement, and no severe reaction was observed. Fifteen patients had hypertrophic scars, eight had hypersensitive scars, and six had recurrent contractures. Conclusions The incidence of flare reaction using tensionfree immobilization postoperatively was low in our study. According to our findings, wound healing problems are rare when tensionless splinting is utilized.Type of study/level of evidence Case series, Level IV, Therapeutic study

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“…As shown in other studies that employ splinting techniques similar to ours [9], the incidence of scar hypertrophy and sensitivity were low.…”

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 90%

The Incidence of Postoperative Flare Reaction and Tissue Complications in Dupuytren's Disease Using Tension-Free Immobilization

Rivlin

Osterman

Jacoby

et al. 2014

Hand (New York, N,Y.)

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“…The treatment does not cure the disease, and recurrence is common (2,3). Possible adverse effects of surgery are vascular or nerve damage, delayed wound healing, scar problems, infection, swelling, complex regional pain syndrome, and loss of finger flexion (4)(5)(6). Some surgeons recommend postoperative hand therapy (7)(8)(9), and according to clinical experience, recovery after surgery takes in general 3 to 6 months (8).…”

Section: Introductionmentioning

confidence: 99%

“…Few studies report assessment of sensibility before and after surgery (20), though 1 study using the Semmes-Weinstein monofilaments report diminished light touch and protective sensation after surgery (17). Scar contracture is another potential complication after surgery (5,6) and should be distinguished from recurrence, i.e. the development of new DD tissue in the operated area (1).…”

Section: Introductionmentioning

confidence: 99%

Hand Function and Quality of Life Before and After Fasciectomy for Dupuytren Contracture

Engstrand¹,

Krevers²,

Nylander³

et al. 2014

The Journal of Hand Surgery

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PurposeTo describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease. MethodsThis prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60 degrees or more from Dupuytren contracture were included. Outcomes measures were range of motion, sensibility, scar pliability, self-reported outcomes on expectations, recovery, and satisfaction with hand function, Disabilities of the Arm, Shoulder, and Hand scores, safety and social issues of hand function, physical activity habits, and quality of life with the Euroqol. ResultsThe extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months 32% considered hand function as fully recovered, and 73%were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder and Hand score and the Euroqol improved over time. 2 ConclusionAfter surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment.

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“…35 While the effectiveness of splinting without surgery is dubious, most surgeons would still advocate it as an adjunct to surgery to maximize finger extension and function. 3,36 After the acute wound healing stage has passed, most surgeons would also continue night splinting to maintain extension in the remodeling phase of wound healing.…”

mentioning

confidence: 99%

Molecular mechanisms and treatment strategies for Dupuytren’s disease

O’Gorman¹,

Vi²,

Gan

2010

TCRM

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Dupuytren's disease (DD) is a common disease of the hand and is characterized by thickening of the palmar fascia and formation of tight collagenous disease cords. At present, the disease is incurable and the molecular pathophysiology of DD is unknown. Surgery remains the most commonly used treatment for DD, but this requires extensive postoperative therapy and is associated with high rates of recurrence. Over the past decades, more indepth exploration of the molecular basis of DD has raised the hopes of developing new treatment modalities. This paper reviews the clinical presentation and molecular pathophysiology of this disease, as well as current and emerging treatment. It also explores the implications of new findings in the laboratory for future treatment.

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A clinical report of the effect of mechanical stress on functional results after fasciectomy for dupuytren's contracture

Cited by 50 publications

References 72 publications

The Incidence of Postoperative Flare Reaction and Tissue Complications in Dupuytren's Disease Using Tension-Free Immobilization

The Incidence of Postoperative Flare Reaction and Tissue Complications in Dupuytren's Disease Using Tension-Free Immobilization

Hand Function and Quality of Life Before and After Fasciectomy for Dupuytren Contracture

Molecular mechanisms and treatment strategies for Dupuytren’s disease

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A clinical report of the effect of mechanical stress on functional results after fasciectomy for dupuytren's contracture

Cited by 50 publications

References 72 publications

The Incidence of Postoperative Flare Reaction and Tissue Complications in Dupuytren's Disease Using Tension-Free Immobilization

The Incidence of Postoperative Flare Reaction and Tissue Complications in Dupuytren's Disease Using Tension-Free Immobilization

Hand Function and Quality of Life Before and After Fasciectomy for Dupuytren Contracture

Molecular mechanisms and treatment strategies for Dupuytren&rsquo;s disease

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Product

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Molecular mechanisms and treatment strategies for Dupuytren’s disease