Outcomes at 7 and 21 years after surgical treatment of Dupuytren's disease by fasciectomy and open-palm technique

Abstract

The goal of this study was to assess the recurrence of Dupuytren's disease and the stability of the functional result after fasciectomy combined with the McCash open-palm technique. From 1989 to 1999, 56 consecutive patients were surgically treated for Dupuytren's disease. In 2003, 40 of these operated patients were reviewed by an independent evaluator; 12 patients were Tubiana stage 1, 16 stage 2, 9 stage 3 and 3 stage 4. Twenty-one of them were reviewed again in 2016 by a second evaluator who was unaware of the clinical results in 2003. The mean follow-up was 7.32 years (range, 4.26 to 12.5 years) at the first review. Recurrence occurred in 7 patients (17.5%) and extension of the disease in 15 (37.5%). Three patients had developed complex regional pain syndrome (CRPS). Mean residual contracture was 19.3°. Average improvement in finger extension was 53°. At the second review, 21 patients were assessed with a mean follow-up of 21.5 years (range, 18.7 to 26.3 years). None of them were re-operated and no extension of the disease was observed. There was no recurrence in patients who had no recurrence in 2003. However, the contracture had worsened in five patients (23.8%), three of whom had a recurrence of the disease in 2003. Mean residual contracture was 31.8°. Recurrence occurs most often in the first few years after surgery. The functional result is stable over time. CRPS and the number of rays operated are the main factors negatively affecting overall improvement of mobility.