Colgajo comisural palmar: su utilidad en el abordaje de la enfermedad de Dupuytren con compromiso de dedos contiguos. [Commissural­ palmar­ flap:­ use­ in­ Dupuytren’s­ disease­ involving­ adjacent­ fingers

Abstract

Background: In Dupuytren’s contracture deciding the type of surgical incision is extremely important, and several options were described. The aim of this study is to evaluate retrospectively the usefulness of palmar commissural flap in Dupuytren’s disease with adjacent fingers involvement. Methods: Between April 2009 and December 2012, 32 patients with Dupuytren’s disease were operated on by the authors. Twelve patients with at least 2 adjacent fingers involvement and the design of a palmar commissural flap. The flaps were evaluated at days 3-5, 15-21, 45-60, and 6 months post-surgery. At the end of the follow-up, recurrence, satisfaction and Quick Dash score were evaluated. Results:­ Thirteen palmar commissural flaps were performed in 12 patients (6 right hands and 6 left hands). The affected adjacent rays were the 4th and 5th fingers (8 cas- es); the 3rd, 4th and 5th fingers (3 cases), and the 3rd and 4th fingers (one case). Average distances of the palmar commissural flap, commissure-vertex was 2.23 cm (range 1.2-4.3), and that of the transverse 2.42 cm (range 1.6 to 3.8). In all cases it was performed according to preoperative planning resection of pathological cords and partial fasciectomy. One case presented distal necrosis, which was treated with open palm technique. Conclusions:­ The palmar commissural flap can identify both the digital pedicle as pathological structures. Its vascularization makes it a safe and easy flap dissection.