Skin grafting prevents recurrence in Dupuytren's disease and extension correlates with fibrosis diathesis score

We present a 58-year-old right-handed man, who consulted us with an 11-year history of Dupuytren’s disease. To correct contracture of the little finger, we performed regional fasciectomy, skin grafting, and distraction arthrolysis of the proximal interphalangeal (PIP) joint using an external fixator. Preoperative or postoperative skeletal traction has been advocated to treat potential or residual stiffness of the PIP joint in Dupuytren’s contracture, but its intraoperative use has not been reported before. Our method has the advantage of treating each problem caused by Dupuytren’s disease. A good range of painless PIP joint motion is achieved by our intraoperative distraction technique without interfering with the skin graft and without reducing extensor tone, while the healing period is shortened by performing all procedures simultaneously.

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Dupuytren’s disease: my personal view

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417715773 ◽

2017 ◽

Vol 42 (7) ◽

pp. 665-672 ◽

Cited By ~ 12

Author(s):

D. Warwick

Keyword(s):

Randomized Control Trial ◽

Treatment Options ◽

Skin Grafting ◽

Dupuytren’S Disease ◽

Personal View ◽

Dupuytren's Disease ◽

Low Threshold ◽

Randomized Control ◽

Trial Evidence ◽

Design Challenges

Dupuytren’s disease is a heterogenous condition for which a palette of treatment options is required. Randomized control trial evidence is sparse; design challenges, such as validated outcome measures, blinding, equipoise, funding and assessment of recurrence, may limit further data accrual. Recurrence has different significance with different treatments and so rates are not directly comparable. The risk of any treatment is a function of both the chance of a complication and the clinical sequelae of that complication. The patient must be intimately involved in choosing treatment and is often trading rapid recovery for a higher chance of recurrence. Health economies are strained and as custodians of healthcare, surgeons should consider whether many patients even need treatment. To minimize the chance of complex, hazardous and expensive revision surgery, a low threshold for primary skin grafting should be applied, especially for those who are young, have dense disease or vulnerable genes.

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