Short-term Outcomes of Partial Fasciectomy in Patients with Dupuytren’s Contracture

Abstract

Objectives: In this study, we aimed to evaluate short-term outcomes of partial fasciectomy in patients with Dupuytren’s contracture. Materials and Methods: A total of 29 patients who underwent partial fasciectomy between October 2019 and March 2022 were retrospectively analyzed. Demographic and clinical characteristics of patients, degree of contracture, functional outcomes, recurrence rate, and satisfaction rate were recorded. All patients underwent Q-DASH scoring. Complications such as wound infection and neurovascular injuries after surgery were evaluated. Results: Of the patients, 26 were males and three were females. The median age was 57 (range, 40 to 74) years. The median follow-up was 12 (range, 11 to 17) months. Pathological examination result was compatible with fibromatosis. Maceration in the wound site was seen in two patients. The mean Q-DASH score is 7.36 (0-22.8). A butterfly drain was placed after surgery in all patients. No recurrence was observed. All patients were satisfied with the surgical treatment. Conclusion: Partial fasciectomy is a useful treatment method with low recurrence and complication rates and high patient satisfaction rates in patients with Dupuytren’s contracture.

Keywords

• Dupuytren’s Contracture
• Partial Fasciectomy
• Butterfly Drain

Ethical Statement

The study was approved by the Ankara City Hospital, No. 1 Clinical Research Ethics Committee Presidency (Approval no: 2586, Date: 24.04.2022).

Dupuytren Kontraktürü Olan Hastalarda Parsiyel Fasiektomi Cerrahisi Kısa Dönem Sonuçları

Abstract

Amaç: Dupuytren kontraktürü ile kliniğimize başvurup parsiyel fasiektomi uyguladığımız hastaların kısa dönem sonuçları değerlendirildi. Gereç ve Yöntem: Çalışmaya, Ekim 2019 ile Mart 2022 tarihleri arasında parsiyel fasiektomi cerrahisi uygulanan 29 hasta dahil edildi. Bu hastaların demografik ve klinik özellikleri, kontraktür dereceleri, fonksiyonel sonuçları, yineleme oranı ve memnuniyet oranları değerlendirildi. Tüm hastalara Q-DASH skorlaması uygulandı. Cerrahi sonrası yara yeri enfeksiyonu ve nörovasküler yaralanma gibi komplikasyonlar değerlendirilmiştir. Bulgular: Hastaların 3’ü bayan, 26’sı erkek idi. Hastaların yaş ortalaması 57 (40-74). Hastalar ortalama 12 ay (11-17) takip edildi. Hastaların ameliyat sonrası patoloji sonuçlarında fibromatozis ile uyumlu bulgu elde edildi. İki hastada yara yerinde masserasyon izlendi. Ortalama Q-DASH puanı 7,36’dır (0-22,8). Hastaların tamamına, ameliyat sonrası kelebek dren yerleştirildi. Hastalarda yineleme izlenmedi. Hastaların tamamı, cerrahi tedaviden memnun kaldıklarını belirtti. Sonuç: Dupuytren kontraktürü nedeni ile düzgün ve başarılı bir şekilde uygulanan parsiyel fasiektomi cerrahisi; nüks, hasta memnuniyeti ve nadir komplikasyon gelişmesi nedeni ile yararlı bir yöntem olduğu göz ardı edilmemelidir

Keywords

• Dupuytren Kontraktürü
• Parsiyel Fasiektomi
• Kelebek Dren

References

1. 1. Lubahn JD. Dupuytren’s Disease, In: Chapman MW (editor) Chapman’s Orthopedic Surgery, Lipincot-Williams and Wilkins, Philadelphia, 2001; pp: 1735-46.
2. 2. Neligan PC. Plastic Surgery, Volume six, Hand and Upper Extremity, In: WAtt Andrew J. Leclercq Caroline, Management of Dupuytren’s disease, 3rd edition: Elsevier, 2013, pp. 345-362.
3. 3. Ng M, Thakkar D, Southam L, et al. A genome-wide association in study of Dupuytren disease reveals 17 additional variants implicated in fibrosis. Am J Hum Gen. 2017;101:417-427.
4. 4. McFarlane RM. On the origin and spread of Dupuytren’s disease. J Hand Surg Am. 2002;27:385-390.
5. 5. Broekstra DC, Groen H, Molenkamp S, et al. A systematic review and meta-analysis on the strenght and consistency of the associations between Dupuytren disease and epilepsy. Plast Reconstr Surg. 2018;141:367e-379e.
6. 6. Descatha A, Carton M, Mediouni Z, et al. Association among work exposure, alcohol intake, smoking and Dupuytren’s disease in a large cohort study (GAZEL). BMJ Open. 2014;4:e004214.
7. 7. Rayan GM. Clinical presentation and types of Dupuytren’s disease. Hand Clinic. 1999;15:87-96.
8. 8. Tubiana R. Evaluation od deformities in Dupuytren’s disease. Ann Chir Main. 1986;5:5-11.

9. 9. Luck JV. Dupuytren’s contracture; a new concept of the pathogenesis correlated with surgical management. J Bone Joint Surg Am. 1959;41:635-664.
10. 10. Rayan GM. Nonoperative treatment of Dupuytren’s disease. J Hand Surg Am. 2008;33:1208-1210.
11. 11. Turesson C. The role of hand therapy in Dupuytren disease. Hand Clin. 2018;34:395-401.
12. 12. Keilholz L, Seegenschmiedt MH, Sauer R. Radiotherapy for prevention of disease progression in early-stage Dupuytren’s contracture: initial and long-term results. Int J Radiat Oncol Biol Phys. 1996;36:891-897.
13. 13. Yin CY, Yu HM, Wang JP, et al. Long-term follow-up of Dupuytren disease after injection of triamcinolone acetonide in Chinese patients in Taiwan. J Hand Surg Eur Vol. 2017;42:678-682.
14. 14. Nanchahal J, Ball C, Davidson D, et al. Anti-tumour necrosis factor therapy for Dupuytren’s disease: a randomised dose response proof of concept phase 2a clinical trial. EBioMedicine. 2018;33:282-288.
15. 15. Coleman S, Gilpin D, Kaplan FT, et al. Efficacy and safety of con-current collagenase clostridium histolyticum injections for multiple Dupuytren contractures. J Hand Surg Am. 2014;39:57-64.
16. 16. Ball C, Izadi D, Verjee LS, Chan J, Nanchahal J. Systematic review of nonsurgical treatments for early Dupuytren’s disease. BMC Musculoskelet Disord. 2016;17:345.
17. 17. McGrouther DA. Dupuytren’s contracture. In: Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier; 2005;159-185.
18. 18. Gelman S, Schlenker R, Bachoura A, et al. Minimally invasive partial fasciectomy for Dupytren’sconracture. Hand. 2012;7:364-369.
19. 19. Therkelsen LH, Skov ST, Laursen M, Lange J. Percutaneous needle fasciotomy in Dupuytren contracture: a register-based, observational cohort study on complications in 3331 treated fingers in 2257 patients. Acta Orthop. 2020;91:326-330.
20. 20. Desai SS, Hentz VR. The treatment of Dupuytren disease. J Hand Surg Am. 2011;36:936-942.
21. 21. Copay AG, Glassman SD, Subach BR, et al. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and Pain Scales. Spine J. 2008;8:968-974.
22. 22. Denkler KA, Park KM, Alser O. Treatment options for Dupuytren’s disease: Tips and Tricks. Plast Reconstr Surg Glob Open. 2022;10:e4046.
23. 23. van Rijssen AL, Ter Linden H, Werker PMN. Five-year results of a randomized clinical trial on treatment in Dupuytren’s disease: percutaneous needle fasciotomy versus limited fasciectomy. Plast Reconstr Surg. 2012;129:469-477.
24. 24. Crean SM, Gerber RA, Graverand MP, et al. The efficacy and safety for of fasciectomy amd fasciotomy for Dupuytren’s contracture in European patients: a structured review of published studies. J Hand Surg Eur. 2011;36:396-407.
25. 25. Sennwald GR. Fasciectomy for treatment of Dupuytren’s disease and early complications. J Hand Surg Am. 1990;15:755-761.
26. 26. Citron ND, Nunez V. Recurrence after surgery for Dupuytren’s disease: a randomized trial of two skin incisions. J Hand Surg Br. 2005;30:563-566.
27. 27. Bulstrode NW, Jemec B, Smith PJ. The complications of Dupuytren’s contracture surgery. J Hand Surgery Am. 2005;30:1021-1025.