gms | German Medical Science

Objectives/Interrogation: Operative treatment for Dupuytren' s contracture includes percutaneous division, partial excision or total excision of the palmar fascia. The aim of this study is to present complications and the long term outcome in a large group of patients in whom the disease was treated with resection of the contracted palmar fascia, only in the affected rays.

Methods: From 2000 to 2016, 234 patients with Dupuytren's contracture were treated with excision of the contracted palmar fascia in the affected rays. Mean age was 68 years (from 37 to 86). The dominant hand was affected in 146 patients. The ring finger was most commonly affected (149 patients). Ninety eight patients presented with two or more finger rays affected. The procedure was performed with axillary block and with a tourniquet application. All diseased tissues (contracted fascia, skin, digital ligaments) were dissected and excised. Excision of the contracted tissues at the proximal phalanx was carried out to restore or improve range of motion. Check rein ligaments in the PIP join were divided if there was stiffness of the joint. When skin was infiltrated by the disease, it was removed and the wound was left open to close by secondary intention. Non diseased palmar fascia of the adjacent finger rays was not excised.

Results and Conclusions: Mean postoperative follow up was 10 years (from 2 to 16). Preoperatively, average extension deficit in the MCP and PIP joint was 38 and 32 degrees respectively. Postoperative values at the final follow up were 10 degrees in both joints presenting improvement of 28 and 22 degrees. Complications occurred in 61 patients (26%) and included 16 recurrences, 15 patients with complex regional pain syndrome, 1 amputation of the distal phalanx of the finger, 3 arthrodeses, 7 infections, 5 injuries of digital nerves that needed immediate repair, 7 sensory neuroapraxias that resolved after 6 months and 7 patients with cold intolerance which resolved at two years postoperatively.

Excision of the affected-contracted palmar fascia is effective in the treatment of Dupuytren's contracture. Although it is technically demanding in the advanced stages, it remains the most effective type of treatment in these late stages. Complications (early and late) are frequent with the most serious being a digital nerve injury, infection, complex regional pain syndrome and recurrence of the disease. Early complications need immediate and appropriate treatment for a satisfactory outcome.