Fasciectomy For Dupuytren Research Articles

Assessing Risk Factors for the Development of CRPS Following Fasciectomy for Dupuytren's Contracture

Assessing Risk Factors for the Development of CRPS Following Fasciectomy for Dupuytren's Contracture

Does postoperative hand elevation reduce swelling? A randomized study

The purpose of this study was to assess the effect of limb elevation on hand swelling after surgery. We prospectively randomized 113 patients undergoing fasciectomy or a trapeziectomy into one of two groups. The first group had the hand elevated postoperatively and the hands of the second group were not elevated. Hand swelling was assessed using a volumetric method. Although the swelling was less in the elevated group this did not reach statistical significance. Subgroup analysis revealed no further significant differences. There were no complications in patients who did not have limb elevation. This study does not support the routine use of elevation for 24 hours after fasciectomy for Dupuytren's disease and trapeziectomy to reduce hand swelling.

A prospective randomised trial of absorbable versus non-absorbable sutures for wound closure after fasciectomy for Dupuytren’s contracture

After fasciectomy for Dupuytren's contracture the wound has traditionally been closed with non-absorbable sutures. A prospective randomised study of 59 patients was undertaken to compare wound closure after fasciectomy with irradiated polyglactin 910 absorbable sutures and non-absorbable sutures. The outcomes studied were: time spent attending to the wound at the first postoperative visit; the patient's pain score at that visit; and any complications. Wound care required significantly more time when non-absorbable sutures were used. There was no significant difference in pain scores or in complications between the two groups. We recommend the use of irradiated polyglactin 910 absorbable sutures for wound closure after fasciectomy as it saves time and resources without compromising wound healing.

A diabetic patient presenting with stiff hand following fasciectomy for Dupuytren's contracture: A case report

Reported is the case of a 68-year-old male presenting with severe wrist and hand stiffness following surgery for a Dupuytren's contracture. Complications of surgery or rehabilitation and complex regional pain syndrome were excluded as factors explaining this stiffness. Given the patient's diabetes mellitus and the striking similarity with the typical diabetic stiff hand, it is suggested that diabetes may have contributed to the development of the complication.

Subacute Nerve Compressions after Trauma and Surgery of the Hand

It is accepted that major injuries of the upper limb may require not only fasciotomies but also nerve decompressions. That nerve compression(s) may occur after less dramatic injuries and "routine" surgery distal to the elbow is less well documented in the literature but well known to experienced clinicians. The aim of this study was to identify a possible link between injuries or elective surgery to the distal upper limb and "subacute nerve compressions." Over a 5-year period, data of patients who developed clinical symptoms of nerve compressions distal to the elbow within 6 months after trauma or elective surgery to the same upper limb that affected postoperative management were collected prospectively. This study identified 91 patients (49 after trauma and 42 after elective surgery). Compression of the median nerve in the carpal tunnel was the most common syndrome (73 cases). Fasciectomy for Dupuytren's disease was the most frequent operation involved (23 cases). The average time from injury or surgery to diagnosis of nerve compression(s) was 8 weeks (range, 1 to 24 weeks). Surgical decompression of the involved nerves was performed in 43 patients (47.2 percent), with an average time from diagnosis to surgery of 30.4 weeks (range, 28 to 44 weeks). In the carpal tunnel syndrome group (47 men and 26 women), mean age was 49 years (men, 48 years; women, 50 years) and the male-to-female ratio was 1.8:1. Subacute nerve compressions should be considered as a complication during the recovery period after injury and surgery of the upper limb.

Predicting the Outcome of Surgery for the Proximal Interphalangeal Joint in Dupuytren’s Disease

We prospectively studied the outcome of limited Dupuytren's fasciectomy, in combination with joint release if necessary, for disease involving 49 proximal interphalangeal joints (PIPJs) to identify factors that predispose to recurrent PIPJ contracture. Thirty-seven patients were treated over a 4-year period. The flexion contracture of the PIPJ was measured before surgery, immediately after surgery, and at more than 1 year after surgery. A mean preoperative flexion contracture of 67 degrees +/- 22 degrees was corrected to 6 degrees +/- 10 degrees at the time of surgery and 25 degrees +/- 25 degrees at the follow-up evaluation. There was a positive correlation between the severity of the preoperative flexion contracture and recurrent deformity, with a preoperative contracture greater than 60 degrees leading to significantly worse outcome. Incomplete correction of PIPJ flexion contracture during surgery and poor postoperative compliance with therapy were also associated with worse recurrent joint contractures. The digit involved and the necessity for joint release did not significantly affect outcome. In the absence of recurrent Dupuytren's disease, severe preoperative deformity, incomplete correction at surgery, and noncompliance with therapy predispose patients to worse PIPJ contracture. Prognostic II.

A Comparison of the Direct Outcomes of Percutaneous Needle Fascioto-my and Limited Fasciectomy for Dupuytren's Disease: A 6–Week Follow-Up Study

A Comparison of the Direct Outcomes of Percutaneous Needle Fascioto-my and Limited Fasciectomy for Dupuytren's Disease: A 6–Week Follow-Up Study

A Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren's Disease: A 6-Week Follow-Up Study

A Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren's Disease: A 6-Week Follow-Up Study

The Incidence of Complex Regional Pain Syndrome After Fasciectomy for Dupuytren's Contracture

Survey of Anesthesiology: December 2006 - Volume 50 - Issue 6 - p 321 doi: 10.1097/01.sa.0000248489.05145.1e

‘Optimum Mobility’ Facelift

Dr Nabil Fanous presented a clear discussion of his theory of the intrinsic mobility of the face. The author noted that the mobility of the superficial musculoaponeurotic system (SMAS) layer is more dominant than the subskin layer. This is an astute observation and has inherent practical applications. The concept of calling this mobility ‘intrinsic’ is a good one. The author dramatically and pictorially described the technique for the preoperative markings. It would have been easier to follow had he used the same side of the face for his diagrams and photographs. The description and intraoperative presentation of his suturing technique was very clear. The author compared the various techniques currently used in achieving facelift surgery. He concluded that it is not always necessary to have an extensive dissection to achieve the end result. This of course is an axiom for all surgery – do no more dissection than required to achieve the end result, whether you are doing a facelift or a fasciectomy for Dupuytren’s contracture. Dr Fanous’ technique of SMAS plication is similar to the less invasive suturing plications of the SMAS that are being presented currently. The author documented the historical evolution of SMAS anatomy and utilization. One must not forget that, 45 years ago, Dr Gustof Aufricht was hauling up and suturing the SMAS – he called it the deep fascia. The pre- and postoperative photographs depicting the results were comparably clear; all of the patients presented had a loose integumentary system. The results were good and demonstrated that what could be achieved from plications of the SMAS only and lateral placation of the platysma only. The author did not show any patients with heavy integumentary systems or fat necks, which would require suction-assisted lipectomy and subplatysma removal of fat.

RETRACTED: (707): Assessing risk factors for the development of CRPS following fasciectomy for Dupuytren’s contracture

RETRACTED: (707): Assessing risk factors for the development of CRPS following fasciectomy for Dupuytren’s contracture

Ulnar-based skin flap for Dupuytren's fasciectomy

The mainstay of treatment for symptomatic Dupuytren's disease is operation. Various skin incisions have been described, showing that there is no single best incision. We describe an ulnar-based skin flap for excision of palmar disease. This flap allows excellent exposure of the diseased area, and provides good access to the palmar aponeurosis including the difficult area on the ulnar side of the little finger. Healing is reliable and digital disease can be approached with a skin extension as required. Recurrent disease can be treated by raising the same flap again.

Unplanned admissions following ambulatory plastic surgery – a retrospective study

Admission for overnight or longer hospital stay from a day-case unit is an unwelcome event. This audit was designed to identify the incidence of unplanned admissions and also to detect the potential factors for such overstays. Details of plastic surgical day-case patients were obtained from the hospital records for a period of 6 months (February 2002 to July 2002). The total number of unplanned admissions was 28 (3.55%). High rates were recorded in patients above the age of 80 years, male patients and body mass index > 30 kg/m2. Duration of surgery (> 45 min) and waiting time in the day surgery unit (> 2.5 h) had significant correlation with the overstays. Grade of the surgeon was not an important determinant factor. Of procedures which resulted in an unexpected admission, the most frequent were otoplasty (8.4%; n = 71) and fasciectomy for Dupuytren's contracture (14.5%; n = 41). Unexpected admissions were also high following rhinoplasty and nipple reconstruction but the total number of operations performed were not significant (n = 12 in each group). Overall, the cause of the overstays were mostly surgical (71.4%) followed by anaesthetic (28.5%) and social (7.1%). With an overall unplanned admission rate of 3.55%, our unit is close to the national standard of 2-3%, as advocated by The Royal College of Surgeons of England. Postoperative bleeding (60%) was the most important surgical reason for overstays followed by intravenous antibiotics, wound drainage, excessive duration of the procedure and additional, unplanned procedures. Among the anaesthetic factors, postoperative pain was the leading cause (62.5%) followed by nausea, vomiting and adverse anaesthetic reaction. The reasons for unplanned admissions are multifactorial and merit appropriate patient selection and proper estimation of the disease process.

Recurrence after surgery for dupuytren's disease: a randomized trial of two skin incisions

We studied the influence of the type of skin incision on the recurrence rate following fasciectomy for Dupuytren's disease. Patients were randomized to a longitudinal incision closed with Z-plasties or a modified Bruner incision closed by Y-V plasties. Follow-up was for at least 2 years or until a recurrence was noted. We found no statistical difference in recurrence rate between patients having these two skin incisions and closures.

An Alternative Approach in the Treatment of Dupuytren's Contracture Skin Defects: First Dorsal Metacarpal Artery Island Flap

Skin defects are often present following surgery for Dupuytren's contracture. The first dorsal metacarpal artery island flap (FDMA) has been used by others for soft tissue reconstruction about the radial and dorsal aspect of the hand, thumb and fingers. We have used it successfully to fill the skin defects often seen following palmar fasciectomy for Dupuytren's contracture. The thin nature of the flap makes it suitable for this application. The FDMA arises from the radial artery just before the radial artery enters the first dorsal interosseous muscle and divides into three branches: 1 to the thumb, 1 to the index finger (radiodorsal branch) and a muscular branch. It is the radiodorsal branch that supplies the skin over the index finger. The island flap based on this artery includes the dorsal terminal branches of the radial nerve and venae comitantes. The flap is formed to include the fascia of the first dorsal interosseous muscle to avoid injury to a possible deep artery and to yield sufficient fat to promote venous drainage. The flap is passed subcutaneously through the first web space and sutured in place to cover the skin defect in the palm. A full thickness skin graft is used to cover the defect over the proximal phalanx of the index finger.

Dupuytren's disease.

Dupuytren's disease.

INTRAMUSCULAR TENOTOMY OF FLEXOR DIGITORUM SUPERFICIALIS IN THE DISTAL FOREARM AFTER SURGICAL EXCISION OF DUPUYTREN'S DISEASE

Contracture of the proximal interphalangeal joint after surgery to excise Dupuytren's disease, despite release of the contributory structures within the finger, can be caused by flexor digitorum superficialis (FDS) contracture. We describe five cases where FDS contracture was released by intramuscular tenotomy in the distal forearm. Standard postoperative therapy for Dupuytren's fasciectomy was used and clinical review showed improved finger extension with no loss of strength. We suggest that intramuscular tenotomy of FDS in the forearm can be used safely where indicated after excision of the Dupuytren's disease.

A clinical report of the effect of mechanical stress on functional results after fasciectomy for dupuytren's contracture

Early postoperative treatment after Dupuytren's fasciectomy traditionally has included the application of mechanical stress to digital extension with splints and exercise. This study examines the effect of mechanical stress, which may compromise nutrient delivery to the tissues, on inflammation, flare, hypertrophic scar, digital range of motion (ROM), and therapy visits. The authors compared functional outcomes in operated digits treated postoperatively with tension applied (TA) and no tension applied (NTA), retrospectively from 1983 to 1993 (TA only) and prospectively from 1993 to 1999 (TA and NTA). The charts of 268 patients who underwent Dupuytren's fasciectomy were reviewed and divided into 2 groups (TA and NTA). Each case was analyzed with respect to age, sex, number of digits operated, postoperative management technique, therapy visits, metacarpophalangeal joint, and proximal interphalangeal joint ROM, degree of flare, and scar. There were significant differences in ROM, scar formation, flare, and treatment time in favor of the NTA technique. The results indicate that postoperative management that prevents applied mechanical tension in the early phases of wound healing decreases complications after this surgery and that no digital motion is lost to extension with the NTA technique. J HAND THER. 2002;15:331-339.

Simultaneous carpal tunnel release and Dupuytren's fasciectomy

Simultaneous operations for carpal tunnel syndrome and Dupuytren's disease have been reported in only one study which recommended staged treatment because there was an 87% complication rate with simultaneous treatment. The present study reviewed simultaneous treatment of 30 patients during a 20-year period. Complications and unfavourable results were compared to similar groups of patients who underwent either Dupuytren's fasciectomy or carpal tunnel release as sole procedures. Early complications (13%) were far less than in previous studies and were easily corrected. The incidence of recurrence and extension (20%) was lower than in the Dupuytren's fasciectomy group and much lower than in previous reports. Simultaneous carpal tunnel release and Dupuytren's fasciectomy are strongly recommended when these conditions are both present in the same hand.

The Treatment of Dupuytrenʼs Contracture by Partial Fasciectomy

A conservative method of partial palmar fasciectomy for Dupuytren's contracture through multiple, short, longitudinal, palmar skin incisions and conventional finger incisions has been presented. Thirty-seven patients with fifty-one hands treated by this method during the past nine years have been under observation. Forty-one hands were classified excellent; five, good; three, fair; and two, poor-one seven years after operation. All hands except two have been markedly improved and no serious complications have occurred. One of the patients with poor results had had an excellent result until a brachial plexus injury was sustained in the involved extremity. The present series is small and a longer observation is necessary, but the described surgical procedure has been followed by rapid wound healing, low morbidity, early return to work, no significant complications, and satisfactory results.