Surgical treatment results for dupuytren's disease

Aykut, Serkan; Baydar, Mehmet; Büyük, Abdul Fettah; Öztürk, İbrahim; Özden, Erdem; Öztürk, Kahraman

doi:10.1590/1413-785220172503164827

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…The residual phase witnesses the nodules regressing into thick cords, resulting in visible cords and severe contractures [ 6 ]. If left untreated, these contractures may lead to deformities, causing a significant decline in the patient's overall quality of life [ 3 , 40 , 41 ]. Among the various treatment options available, LF and CCH injections have garnered significant attention [ 12 ].…”

Section: Reviewmentioning

confidence: 99%

Comparing Complications and Patient Satisfaction Following Injectable Collagenase Versus Limited Fasciectomy for Dupuytren’s Disease: A Systematic Review and Meta-Analysis

Alhebshi,

Bamuqabel,

Alqurain

et al. 2024

Cureus

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Dupuytren's disease (DD) is a fibroproliferative disorder that manifests as an abnormal growth of myofibroblasts, causing nodule formation and contractures and affecting digit function. If left untreated, these contractures can lead to a loss of mobility and potentially impact hand function. This systematic review critically compares and evaluates the existing literature on the complications and patient satisfaction following injectable collagenase Clostridium histolyticum (CCH) versus limited fasciectomy (LF) for DD. We performed a comprehensive search of the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), The Cochrane Library, and Excerpta Medica database (EMBASE) databases from 2006 to August 2023. This research targeted all clinical studies involving adults who underwent injectable collagenase and/or limited fasciectomy in the management of DD. Out of the 437 identified studies, only 53 were considered eligible for our analysis, and merely 14 met our inclusion criteria. These selected studies encompassed a total of 967 patients with 1,344 treated joints, with an average follow-up duration of 19.22 (ranging from one to 84.06) months. Within this cohort, 498 joints from 385 patients underwent LF, while 846 joints from 491 patients received CCH injections. Notably, among the 491 patients treated with CCH, 1,060 complications were reported, averaging 2.15 complications per patient, with the most common being contusion/bruising/hematoma/ecchymosis (22.54%), and edema/swelling (18.96%). In contrast, among the 385 patients treated with LF, only 97 complications were reported, translating to 0.25 complications per patient, with the most frequent being paraesthesia or numbness (23.7%), scar sequelae like skin laceration, tear, fissure, or hypertrophic scar (23.7%), and neuropraxia or nerve injury (22.6%). Our meta-analysis indicates that paraesthesia or numbness is more frequently observed in LF than CCH injections, although without statistical significance, with a risk ratio (RR) of 0.39 (95% confidence interval (CI) 0.13-1.18, p-value 0.1). However, scar sequelae (hypertrophic scar, skin laceration, tear, or fissure) show a contrasting pattern, being more commonly associated with CCH injections than LF, with an RR of 1.98 (95% CI 0.26-14.85, p-value 0.51), which, upon eliminating the source of heterogeneity, becomes statistically significant, with an RR of 4.98 (95% CI 1.40-17.72, p-value 0.01). Our data revealed a higher frequency of complications with CCH compared to LF, although more severe adverse effects were observed in the LF group, such as neuropraxia or nerve injury. Scar sequelae were more common with CCH injections. Despite both treatments showing increased patient satisfaction at the final follow-up, CCH injection resulted in earlier improvements in satisfaction.

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Section: Reviewmentioning

confidence: 99%

Comparing Complications and Patient Satisfaction Following Injectable Collagenase Versus Limited Fasciectomy for Dupuytren’s Disease: A Systematic Review and Meta-Analysis

Alhebshi,

Bamuqabel,

Alqurain

et al. 2024

Cureus

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“…Но поскольку наш обзор посвящен способам замещения дефектов кожи после апоневрэктомии, то мы будем анализировать только хирургические методики. Среди хирургических способов лечения контрактуры Дюпюитрена выделяют радикальную (тотальную), сегментарную и субтотальную (частичную) апоневрэктомии [7,29].…”

Section: способы лечения контрактуры дюпюитренаunclassified

“…Несмотря на это, в последние десятилетия появляется все больше статей, посвященных миниинвазивным методикам лечения (игольная апоневротомия, ферментативная апоневротомия) [5,6]. В первую очередь это связано с большим количеством ранних и поздних послеоперационных осложнений, которые колеблются в диапазоне от 3,6 до 46,0%, а также со сложностью пластического этапа операции при больших дефектах кожи [7,8,9]. Несмотря на то, что количество осложнений миниинвазивных способов лечения меньше (1-2%), частота рецидивов при их использовании составляет 80-90% в течение первых трех лет после манипуляции, тогда как при субтотальной апоневрэктомии количество рецидивов достигает 34% [5,6,7,8,9].…”

Section: Introductionunclassified

Skin Closure After Subtotal Aponeurectomy in Severe Dupuytren’s Contracture: Review

Idrisov¹,

Rodomanova

2022

Traumatology and Orthopedics of Russia

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Introduction. One of the significant problems of surgical treatment of Dupuytren's contracture is a deficiency of the skin as a result of suturing the wound after subtotal aponeurectomy. The size of the defect depends on the severity of the pathology. In the early stages of the disease, Z-plasty is widely used, but this method of plastic replacement does not completely cover the defect formed after surgical treatment of contracture of III-IV severity, especially when several fingers of the hand are lesioned. The purpose of the study. The purpose of the review is a comparative analysis of methods of plastic replacement of skin deficiency after subtotal aponeurectomy in patients with III-IV degree of severity of Dupuytren's contracture. Various tactics of treatment of this category of patients are described, including distraction elimination of contracture and further aponeurectomy, as well as various methods of plastic replacement of skin defects formed after resection of altered areas of palmar aponeurosis and elimination of contracture. Each of the proposed methods of surgical treatment has its advantages and disadvantages. Conclusions. An analysis of the relevant scientific literature has shown that the most common method of eliminating soft tissue deficiency after aponeurectomy is Z-plasty. However, due to an increase in the severity of the disease, its effectiveness decreases. To date, there is no consensus regarding the approach to the altered site of aponeurosis and there is no single method for eliminating tissue deficiency in the III-IV degree of the disease.

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“…Одной из причин большого количества осложнений, помимо возраста и сопутствующей патологии, является обращение пациентов за помощью на поздней стадии заболевания, когда наступает значительное ограничение функции кисти [7]. При использовании мини-инвазивных способов лечения данной патологии количество осложнений составляет не больше 1-2%, однако частота рецидивов варьирует в пределах 80-90% в течение первых 3 лет после манипуляции, тогда как при субтотальной апоневрэктомии их количество достигает 34% [5,8].…”

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