“…The benefits of adipose tissue rich in stem cells in the treatment of cicatricial contractures are described in several articles. ( 6 )- ( 9 ), ( 15 These benefits are related to the inhibition of myofibroblasts and the restoration of subcutaneous atrophy by fat graft. ( 16 …”
Objective: Dupuytren’s disease is a genetic disorder related to the proliferation of myofibroblasts. The pluripotent property of stem cells present in adipose tissue inhibits myofibroblast proliferation. Our study sought to evaluate the effect of stem cell-rich fat grafts in patients that underwent limited fasciotomy. Methods: We studied 45 patients, in a single-blind, prospective, randomized clinical trial. All patients underwent limited fasciotomy. In one group, fat graft was injected. Results: The total passive extension deficit results did not exhibit a significant difference. Fat group exhibited worse functional score at 6 months and 1 year postoperatively, such as higher complication rates (43%), when compared with control group (8%), and more pain at 6 weeks follow-up. Conclusion: Fat grafting associated with limited fasciotomy promotes worse functional results compared to conventional limited fasciotomy in the short term. However, long-term results and recurrence rates should be further assessed. Level of Evidence II, Prospective comparative study.
“…The benefits of adipose tissue rich in stem cells in the treatment of cicatricial contractures are described in several articles. ( 6 )- ( 9 ), ( 15 These benefits are related to the inhibition of myofibroblasts and the restoration of subcutaneous atrophy by fat graft. ( 16 …”
Objective: Dupuytren’s disease is a genetic disorder related to the proliferation of myofibroblasts. The pluripotent property of stem cells present in adipose tissue inhibits myofibroblast proliferation. Our study sought to evaluate the effect of stem cell-rich fat grafts in patients that underwent limited fasciotomy. Methods: We studied 45 patients, in a single-blind, prospective, randomized clinical trial. All patients underwent limited fasciotomy. In one group, fat graft was injected. Results: The total passive extension deficit results did not exhibit a significant difference. Fat group exhibited worse functional score at 6 months and 1 year postoperatively, such as higher complication rates (43%), when compared with control group (8%), and more pain at 6 weeks follow-up. Conclusion: Fat grafting associated with limited fasciotomy promotes worse functional results compared to conventional limited fasciotomy in the short term. However, long-term results and recurrence rates should be further assessed. Level of Evidence II, Prospective comparative study.
“…After 5 years follow-up, however, the recurrence for percutaneous needle aponeurotomy and lipofilling was 74%, compared with 39% for LF. Recovery however was faster, and complications were less with percutaneous needle aponeurotomy and lipofilling than with LF ( Hovius et al., 2011 ; Hovius et al., 2015 ; Kan et al., 2016 ). Figure 5.…”
The author presents his transition of his preferred methods for managing acute trauma and degenerative and congenital conditions of the hand. Based on his career-long experience, he discusses conceptual evolution and current status of treatment of Dupuytren’s disease and several congenital anomalies of the hand.
“…There is also emerging evidence advocating for new minimally invasive surgical techniques such as the percutaneous aponeurotomy and lipofilling procedure. 48,49 Trials are needed to compare these techniques to more popular surgical techniques. Further, given the prevalence of the percutaneous aponeurotomy and lipofilling procedure in clinical practice, the tracer may benefit from differentiating between patients receiving cordotomy alone versus the combined percutaneous aponeurotomy and lipofilling procedure.…”
Background:
The American Board of Plastic Surgery collects data on 20 common plastic surgery operations as part of the Continuous Certification process. The goal of this study was to describe clinical trends in Dupuytren contracture repair since 2008 as they relate to evidence-based medicine articles published in this timeframe.
Methods:
Cumulative tracer data for Dupuytren contracture were reviewed for the period from February of 2008 to March of 2020 and compared with evidence-based medicine articles published in Plastic and Reconstructive Surgery. Topics were categorized as (1) pearls, addressed in both the tracer data and evidence-based medicine articles, (2) topics only addressed in tracer data, and (3) topics only addressed in evidence-based medicine articles.
Results:
As of March of 2020, 230 cases of Dupuytren contracture had been entered. The median age at time of surgery was 65 years (range, 38 to 91 years). Practice patterns from 2008 through 2014 were compared with those between 2015 and 2020. The most common surgical technique was limited fasciectomy (62 percent of cases). Differences in practice between these time periods included decrease in the use of radical fasciectomy (34 percent versus 16 percent, p = 0.002), increase in percutaneous cordotomy (0 percent versus 13 percent), and increase in the use of collagenase injections (0 percent versus 9 percent, p = 0.001). Use of Bier blocks increased (1 percent versus 7 percent), and tourniquet use decreased (97 percent versus 80 percent). Significant changes were also noted in postoperative management.
Conclusion:
By examining American Board of Plastic Surgery tracer data, the authors have described national trends in presentation and surgical techniques for Dupuytren contracture repair over a 14-year period.
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