gms | German Medical Science

Objectives/Interrogation: There are multiple studies about effectiveness of primary treatment in Dupuytren's disease. This is however not the case concerning treatment effectiveness of recurrent disease. Therefore, the primary aim of this study is to compare treatment effectiveness of initial and repeated surgery in patients with Dupuytren's disease.

Methods: Patients who underwent both initial and repeated treatment were selected from a prospectively maintained database consisted of finger goniometry and the Michigan Hand Outcomes Questionnaire (MHQ) prior to treatment and 3 months afterwards. Treatment effectiveness was measured as improvement in extension deficit and patient-reported hand function. In addition, measurements at intake of both treatments were compared. Subgroup analysis was done to evaluate influence of type of surgery of initial treatment on outcomes of repeated treatment. Finally, complications were scored after both treatments.

Results and Conclusions: 114 Patients were included in the final analyses. In the majority of the patients, the initial treatment was needle fasciotomy (49%) or limited fasciectomy (40%), whereas most patients (79%) underwent a limited fasciectomy for their recurrent contracture. Improvement in extension deficit and MHQ outcomes was equal for initial and repeated treatments. Extension deficit and MHQ were significant worse at intake of repeated treatment compared to these outcomes at intake of initial treatment. In addition, patients who initially underwent needle fasciotomy achieved a better contracture reduction after repeated treatment compared to those who underwent limited fasciectomy as initial treatment. A total of 23 complications were observed. The largest groups of complications were alterations in sensation (e.g. pain or numbness), 10 out of 23, and problems with scar tissue (e.g. adhesions or scar tissue contraction), 6 out of 23. The majority of complications, 14, were seen after a limited fasciectomy for recurrent disease.

This study demonstrates that treatment of recurrent Dupuytren's disease is as effective as initial treatment in reducing contracture and improving patient-reported hand function, despite larger extension deficit and worse self-assessed hand function before undergoing repeated treatment. Furthermore, needle fasciotomy for initial treatment results in better outcomes of repeated treatment. These findings can be used for a more evidence-based preoperative counseling with patients with recurrent Dupuytren's disease.