The lateral-dorsal transposition flap for closure of a palmar soft tissue defect of the proximal phalanx on the little finger after limited fasciectomy in recurrent Dupuytren's contracture

Abstract

Closure of a palmar soft tissue defect of the proximal phalanx after limited fasciectomy in recurrent Dupuytren's contracture. A palmar soft tissue defect between the distal flexion crease of the palm and the flexion crease of the proximal interphalangeal joint (PIP) after limited fasciectomy in Dupuytren's contracture. Scars at the lateral-dorsal portion of the proximal phalanx (e.g., after burns). Modified incision after Bruner ("mini-Bruner"). Removal of the involved fascial cord. If necessary, arthrolysis of the PIP. Raising the lateral-dorsal transposition flap from distal to proximal and rotating it into the palmar soft tissue defect of the proximal phalanx. Closure of the donor site with a skin transplant. Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2days. Afterwards static dorsal splint and daily physiotherapy. Between 2002 and 2007, a total of 32lateral-dorsal transposition flaps in 30patients with recurrent Dupuytren's disease of the little finger underwent surgery. In a retrospective study, 19patients with 20flaps were available for follow-up evaluation after a mean of 6years. All flaps had healed. The median flexion contracture of the metacarpophalangeal joint was 0° (preoperatively, 20°), and of the PIP 20° (preoperatively, 85°) according to Tubiana stage1 (preoperatively, Tubiana stage3). The median grip strength of both the operated and the contralateral hand was 39kg. The DASH score averaged 11points. Overall, 11patients were very satisfied, 6patients were satisfied, 1patient was less satisfied, and 1patient was unsatisfied.