Surgical Treatment of Dupuytren’s Contracture; Results and Complications of Surgery: Our Experience

Abstract

Dupuytren's disease is one of the fibro-proliferative conditions affecting the palmar and digital fascia. This disease has been known to surgeons and treated by them for at least 200 years. Dupuytren's disease is very common in Northern Europe and also in countries inhabited by immigrants from Northern Europe. Dupuytren's contracture is stated to be uncommon in Indian subcontinent and very little has been written about this disease in India. The authors have however come across 30 patients with Dupuytren's contracture and they are the subject of this paper, with special emphasis on its surgical correction and complications of surgical treatment. Patients were categorized into stages I, II and III as per the severity of disease. Regional fasciectomy was performed in 90% of the patients and extensive fasciectomy in 10% of patients. Most of wounds were closed by primary closure with z-plasty. In rest of the patients free skin grafts were used to close the wound, when primary closure was not possible. The patients were followed up regularly for 5 years and the results of surgical treatment were categorized into excellent, good, fair and poor. The results were excellent in 23 patients (76.66%), good in six patients (20%) and fair in one patient (3.33%). Post operative edema and some stiffness was seen in two patients. Wound infection was seen in one patient and haematoma in one patient. The correct surgical technique and meticulous post operative care is needed to achieve higher rates of correction and to limit the complications and recurrence.

Limited palmar fasciectomy for bilateral Dupuytren’s contracture

“…9 In a study by Khan et al patients were categorized into 3 stages, Stage I is presence of a thickened nodule and band in the palmar aponeurosis and often associated with skin puckering, stage II is stage I plus limitation of extension and stage III is stage II plus flexion contracture. 11 Surgical fasciectomy is a documented effective treatment method, but complications such as digital neurovascular injury and wound-related problems are common. [8][9][10][11][12] Limited fasciectomy (LF) has proven to be curative and effective and most commonly performed of the surgical interventions.…”

“…11 Surgical fasciectomy is a documented effective treatment method, but complications such as digital neurovascular injury and wound-related problems are common. [8][9][10][11][12] Limited fasciectomy (LF) has proven to be curative and effective and most commonly performed of the surgical interventions. 12 Denkler et al reported that the limited fasciectomy technique has the lowest recurrence rate out of all surgical and non-surgical methods and is currently the most popular technique used.…”

Surgical treatment results for dupuytren's disease

“… 3 Although fasciectomy and selective fasciectomy are similar in terms of functionality and recurrence rates, complication and morbidity rates are strikingly higher with radical fasciectomy. 16 Khan et al 13 employed regional fasciectomy in 27 of their 30 patients and reported excellent and good results in 97% of the patients after five years of follow-up. Özkaya et al 4 retrospectively evaluated patients who underwent partial selective fasciectomy over a 10-year period and observed complications in 16.6% of the patients, but no recurrence.…”

“…All patients signed a free and informed consent form. Patients were staged according to system by Khan et al 13 ( Table 1 ) In addition, smoking habits, alcohol use, regular use of medications and accompanying chronic diseases were noted for each patient. Since this study is retrospective in nature, institutional review board approval was not necessary.…”

“…We grouped our results into four sections, as suggested by Khan et al 13 According to this classification, full movement/function and no recurrence was considered 'excellent,' mild loss of flexion-extension in fingers with minor impact on function was considered 'good,' loss of function with joint stiffness, recurrence and limitation in daily activities was considered 'fair,' and severe loss of function and failure to recover after the first contracture was considered 'poor.' ( Table 2 )…”