gms | German Medical Science

Objectives/Interrogation: Several pathogenetic hypothesis were described for fascia proliferation in Dupuytren's disease. The surgical approach aim to treat the macroscopic manifestation of finger retraction in the most advanced recurrent disease. It became necessary to investigate the cellular Dupuytren develop to find out new therapeutic approach to permit a more sparing surgery and to treat all severe cases. In fact, some clinical studies assess as, in addition to fascia, palmar skin and fat-derived cells may be a potential source of cells causing the Dupuytren disease. Based on this observation, the introduction of the fat graft palmar replacement by lipofilling technique joint to traditional aponeurectomy have shown promising long term good result.

Methods: A retrospective study was performed on patients treated for Dupuytren recurrence by selective aponeurectomy and fat graft. 44 patients, with five years of follow, were treated for recurrent Dupuytren disease (30 patients previously undergoing aponeurectomy and 14 patients undergoing infiltration with collagenase). An aponeurectomy was performed in all cases with complete removal of affected fascia. At the end of procedure all the surgical site and neighboring rays were filled by fat graft from the abdomen (mean 12cc). Primary endpoint was skin texture, quality of scar, tendon gliding, pain and complications. Secondary endpoint was to observe the recurrence of the disease by echography evaluation.

Results and Conclusions: The patients were evaluated after 3 years from surgery to verify effects. Good results emerged from many patients concerning: the degree of flexion and extension of the operated fingers, the degrees of active and passive mobility of the MCF and IF joint, pain, sensitivity, flexion strength and scars. Only three patients presented a relapse. All patients underwent ultrasound evaluations six months and on1 and 3 year after surgery, documenting the persistence of adipose tissue in rays involved. Fat grafting is a common procedure in reconstructive and aesthetic surgery, colled as "lipofilling". For the presence of adipose derived stem cell (ADSC) and cytokines it is employed in several clinical procedures as severe Dupuytren especially for its possible role in modulating the fibroproliferative diathesis.

The morphological, functional results and limited incidence of recurrences in treated patients would seem to confirm that aponeurectomy and lipofilling may represent a new weapon in cases of aggressive disease.