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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Severe Dupuytrens Contracture treated by the McCash Technique (open palm) and Full Thickness Skin Grafts to the Involved Fingers: Results and Complications

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  • Joseph Imbriglia - Hand and UpperEx Center, University of Pittsburgh, Wexford, United States
  • presenting/speaker Glenn Glenn Buterbaugh - Hand and UpperEx Center, University of Pittsburgh, Wexford, United States
  • William Hagberg - Hand and UpperEx Center, University of Pittsburgh, Wexford, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1891

doi: 10.3205/19ifssh0478, urn:nbn:de:0183-19ifssh04783

Published: February 6, 2020

© 2020 Imbriglia et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: We hypothesized that using an open palm technique and full thickness skin grafts would result in satisfactory correction of the flexion contractures with minimal complications.

Methods: 95 patients with severe Dupuytrens contracture were operated on between 2010 and 2017 by the senior authors. The patients were evaluated pre and post op by the surgeons. The average follow up was 18 months.

We evaluated:

1.
ROM of MCPs + PIPs pre and post op
2.
Post- operative pain
3.
Time for healing of the open wound
4.
Complications:
    • flare reaction (RSD)
    • loss of FTSG
    • nerve injury

Results: Patients were all seen initially at 3-5 days post op. They were then followed 2 weeks post-op. The average VAS pain score was 3.4 at 3-5 days post op and all patients were off any strong medication by 1 week.

ROM pre-op post-op

MCP5 degrees 55 degrees

PIP25 degrees 75 degrees

Time for healing of open of open wound was 18 days.

Complications:

  • flare reaction (RSD symptoms)- 3
  • loss of FTSG- 2
  • nerve injury/ neuropraxia- 2

Conclusion: Severe Dupuytrens contracture can safely be treated by using an open palm technique and small transverse finger incisions. Defects in the fingers are treated by full thickness skin grafts. The use of the open technique and small incisions results in very few severe complications.