Dupuytren’s contracture: Long-term outcomes and complications after operative treatment with resection of the contracted palmar fascia.

  • E.D. Athanaselis
  • F. Papageorgiou
  • D. Deligeorgis
  • Ζ.Η. Dailiana
  • K. Malizos
  • S.E. Varitimidis
Keywords: Dupuytren’s disease, nodules and cords, palmar fascia contracture, fasciectomy, open palm technique

Abstract

Dupuytren’s disease is a condition that affects skin fascia of palm and fingers resulting in the formation of nodules and cords, and the sequential “Dupuytren’s contracture”. Fingers are pulled inward and towards the palm, interfering with hand function. Operative treatment of Dupuytren’s contracture includes percutaneous division and partial or total excision of the affected palmar fascia. Partial fasciectomy remains the most effective type of treatment in advanced, late stages, although technically demanding. Complications are frequent with the most serious being a digital nerve and artery injury, haematoma formation and skin necrosis, infection, complex regional pain syndrome and recurrence of the disease.

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Author Biographies

E.D. Athanaselis

Department of Orthopaedic Surgery & Musculoskeletal Trauma, University of Thessaly, Greece

F. Papageorgiou

Department of Orthopaedic Surgery & Musculoskeletal Trauma, University of Thessaly, Greece

D. Deligeorgis

Department of Orthopaedic Surgery & Musculoskeletal Trauma, University of Thessaly, Greece

Ζ.Η. Dailiana

Department of Orthopaedic Surgery & Musculoskeletal Trauma, University of Thessaly, Greece

K. Malizos

Department of Orthopaedic Surgery & Musculoskeletal Trauma, University of Thessaly, Greece

S.E. Varitimidis

Department of Orthopaedic Surgery & Musculoskeletal Trauma, University of Thessaly, Greece

References

1. Wilbrand S, Ekbom A, Gerdin B. The sex ratio and rate of reoperation for Dupuytren’s contracture in men and women. J Hand Surg Br. 1999;24(4):456-59. doi:10.1054/jhsb.1999.0154.
2. Dupuytren G. De la rétraction des doigts par suite d’une affection de l’ aponévrose palmaire-description de la maladie-opération chirurgicale qui convient dans ce cas. J Univ Hebd Med Chir Prat Inst Med 1831;5:349-65.
3. Thurston A. Dupuytren’s disease or Cooper’s contracture?: Kenneth Fitzpatrick Russell Memorial Lecture. ANZ J Surg. 2003;73(7):529-35. doi:10.1046/j.1445-1433.2003.02645.x.
4. Turesson C, Kvist J, Krevers B. Experiences of men living with Dupuytren’s disease-Consequences of the disease for hand function and daily activities [published online ahead of print, 2019 Aug 30]. J Hand Ther. 2019;S0894-1130(18)30296-5. doi:10.1016/j.jht.2019.04.004
5. von Campe A, Mende K, Omaren H, et al. Painful nodules and cords in Dupuytren disease. J Hand Surg Am. 2012;37(7):1313-18. doi:10.1016/j.jhsa.2012.03.014
6. Hu FZ, Nystrom A, Ahmed A, et al. Mapping of an autosomal dominant gene for Dupuytren’s contracture to chromosome 16q in a Swedish family. Clin Genet. 2005;68(5):424-29. doi:10.1111/j.1399-0004.2005.00504.x.
7. Renard E, Jacques D, Chammas M, et al. Increased prevalence of soft tissue hand lesions in type 1 and type 2 diabetes mellitus: various entities and associated significance. Diabete Metab. 1994;20(6):513-21.
8. Luck JV. Dupuytren’s contracture; a new concept of the pathogenesis correlated with surgical management. J Bone Joint Surg Am. 1959;41-A(4):635-64.
9. Sayadi LR, Alhunayan D, Sarantopoulos N, et al. The Molecular Pathogenesis of Dupuytren Disease: Review of the Literature and Suggested New Approaches to Treatment. Ann Plast Surg. 2019;83(5):594-600.doi:10.1097/SAP.0000000000001918.
10. Mansur HG, Oliveira ER, Gonçalves CB. Epidemiological analysis of patients with Dupuytren’s disease. Rev Bras Ortop. 2017;53(1):10-14. Published 2017 Dec 14. doi:10.1016/j.rboe.2017.12.003.
11. Tajika T, Kobayashi T, Kaneko T, et al. Epidemiological study for personal risk factors and quality of life related to Dupuytren’s disease in a mountain village of Japan. J Orthop Sci. 2014;19(1):64-70. doi:10.1007/s00776-013-0478-y.
12. Beck W. Untersuchungen über die Häufigkeit der Dupuytrenschen Kontraktur [Studies on the incidence of Dupuytren’s contracture]. Monatsschr Unfallheilkd Versicherungsmed. 1954;57(3):69-82.
13. Mathieu S, Naughton G, Descatha A, et al. Dupuytren’s Disease and exposure to vibration: Systematic review and Meta-analysis. Joint Bone Spine. 2020;87(3):203-7. doi:10.1016/j.jbspin.2020.02.001.
14. Hueston JT. Dupuytren’s contracture. Livingstone, Edinburgh 1963.
15. Hueston JT. Dorsal Dupuytren’s disease. J Hand Surg Am. 1982;7(4):384-87. doi:10.1016/s0363-5023(82)80149-4.
16. Kan HJ, de Bekker-Grob EW, van Marion ES, et al. Patients’ Preferences for Treatment for Dupuytren’s Disease: A Discrete Choice Experiment. Plast Reconstr Surg. 2016;137(1):165-73. doi:10.1097/PRS.0000000000001878.
17. Knobloch K, Kuehn M, Vogt PM. Focused extracorporeal shockwave therapy in Dupuytren’s disease-a hypothesis. Med Hypotheses. 2011;76(5):635-37. doi:10.1016/j.mehy.2011.01.018.
18. Rivers JK, Zarbafian M. Improvement of Dupuytren Disease After treatment with a Fractionated CO2 Laser [published online ahead of print, 2019 Sep 24]. Dermatol Surg. 2019;10.1097/DSS.0000000000002159. doi:10.1097/ DSS.0000000000002159.
19. Kadhum M, Smock E, Khan A, et al. Radiotherapy in Dupuytren’s disease: a systematic review of the evidence. J Hand Surg Eur Vol. 2017;42(7):689-92. doi:10.1177/1753193417695996.
20. Sayadi LR, Alhunayan D, Sarantopoulos N, et al. The Molecular Pathogenesis of Dupuytren Disease: Review of the Literature and Suggested New Approaches to Treatment. Ann Plast Surg. 2019;83(5):594-600. doi:10.1097/SAP.0000000000001918.
21. Gilpin D, Coleman S, Hall S, et al. Injectable collagenase Clostridium histolyticum: a new nonsurgical treatment for Dupuytren’s disease. J Hand Surg Am. 2010;35(12):2027-38.e1. doi:10.1016/j.jhsa.2010.08.007.
22. Scherman P, Jenmalm P, Dahlin LB. Three-year recurrence of Dupuytren’s contracture after needle fasciotomy and collagenase injection: a two-centre randomized controlled trial. J Hand Surg Eur Vol. 2018;43(8):836-40. doi:10.1177/1753193418786947.
23. Skov ST, Bisgaard T, Søndergaard P, et al. Injectable Collagenase Versus Percutaneous Needle Fasciotomy for Dupuytren Contracture in Proximal Interphalangeal Joints: A Randomized Controlled Trial. J Hand Surg Am. 2017;42(5):321-28.e3. doi:10.1016/j.jhsa.2017.03.003.
24. Roush TF, Stern PJ. Results following surgery for recurrent Dupuytren’s disease. J Hand Surg Am. 2000;25(2):291-96. doi:10.1053/jhsu.2000.jhsu25 a0291.
25. Bainbridge C, Dahlin LB, Szczypa PP, et al. Current trends in the surgical management of Dupuytren’s disease in Europe: an analysis of patient charts. Eur Orthop Traumatol. 2012;3(1):31-41. doi:10.1007/s12570-012-0092-z.
26. Leafblad ND, Wagner E, Wanderman NR, et al. Outcomes and Direct Costs of Needle Aponeurotomy, Collagenase Injection, and Fasciectomy in the Treatment of Dupuytren Contracture. J Hand Surg Am. 2019;44(11):919-27. doi:10.1016/j.jhsa.2019.07.017.
27. McFarlane RM. Dupuytren’s disease. J Hand Surg Br. 1996;21(4):566-67. doi:10.1016/s0266-7681(96)80080-5.
28. Boyer MI, Gelberman RH. Complications of the operative treatment of Dupuytren’s disease. Hand Clin. 1999;15(1):161-viii.
29. Schneider LH, Hankin FM, Eisenberg T. Surgery of Dupuytren’s disease: a review of the open palm method. J Hand Surg Am. 1986;11(1):23-27. doi:10.1016/s0363-5023(86)80094-6.
30. Zoubos AB, Stavropoulos NA, Babis GC, et al. The McCash technique for Dupuytren’s disease: our experience. Hand Surg. 2014;19(1):61-67. doi:10.1142/S0218810414500117.
31. McCash CR. The open palm technique in Dupuytren’s contracture. Br J Plast Surg. 1964;17:271-80. doi:10.1016/s0007-1226(64)80043-6.
32. Malingue E. Une voie d’ abord « standart » dans la maladie de Dupuytren des doigts longs. Trucs et Astuces tome 2. Ed. Sauramps médical;2002.
33. Cronin TD. The cross finger flap: a new method of repair. Am Surg. 1951;17(5):419-25.
34. Ekerot L. The distally-based dorsal hand flap for resurfacing skin defects in Dupuytren’s contracture. J Hand Surg Br. 1995;20(1):111-14. doi:10.1016/s0266-7681(05)80028-2.
35. Le Gall H, Dautel G. Skin Expansion Due to the Dupuytren Cord Allows to Design Local Flaps to Facilitate Skin Closure in Severe Cases: The 3-flap: Surgical Technique and Clinical Evaluation [published online ahead of print, 2019 Dec 23]. Tech Hand Up Extrem Surg. 2019;10.1097/BTH.0000000000 000271. doi:10.1097/BTH.0000000000000271.
36. Degreef I, Vererfve PB, De Smet L. Effect of severity of Dupuytren contracture on disability. Scand J Plast Reconstr Surg Hand Surg. 2009;43(1):41-42. doi:10.1080/02844310802410125.
37. Zyluk A, Jagielski W. The effect of the severity of the Dupuytren’s contracture on the function of the hand before and after surgery. J Hand Surg Eur Vol. 2007;32(3):326-29. doi:10.1016/J.JHSB.2006.10.007.
38. Chung KC, Burns PB, Sears ED. Outcomes research in hand surgery: where have we been and where should we go? J Hand Surg Am. 2006;31(8):1373-79. doi:10.1016/j.jhsa.2006.06.012.
39. Mendelaar NHA, Poelstra R, van Nieuwenhoven CA, et al. Outcome of Recurrent Surgery in Dupuytren’s Disease: Comparison with Initial Treatment. Plast Reconstr Surg. 2019;144(5):828e-35e. doi:10.1097/PRS.00 00000000006150.
40. Sanjuan-Cervero R, Carrera-Hueso FJ, Vaquero-Perez M, et al. Recurrent Dupuytren’s disease after fasciectomy and collagenase injection are histologically indistinguishable. J Hand Surg Eur Vol. 2020;45(5):508-12. doi:10.1177/1753193419900483.
41. Hueston J. The role of the skin in Dupuytren’s disease. Ann R Coll Surg Engl. 1985;67(6):372-75.
Published
2020-12-11