Clinical Results of Dermofasciectomy for Dupuytren’s Disease in Japanese Patients

2007 ◽  
Vol 32 (4) ◽  
pp. 407-410 ◽  
Author(s):  
Y. ABE ◽  
T. ROKKAKU ◽  
K. KUNIYOSHI ◽  
T. MATSUDO ◽  
T. YAMADA
Keyword(s):  
Skin Graft ◽  
Japanese Patients ◽  
Clinical Results ◽  
Metacarpophalangeal Joint ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
The Mean ◽  
A Minor

The surgical outcomes of dermofasciectomy for Dupuytren’s disease were evaluated in nine hands of eight patients in a Japanese population. The patients were examined for postoperative complications, problems associated with the skin graft, evidence of recurrent disease, sensation over the graft and pre- and postoperative range of motion at the metacarpophalangeal and the proximal interphalangeal joints. The mean two-point discrimination over the skin graft was 14 mm. The mean remaining flexion contracture at the metacarpophalangeal joint was 5° and that at the proximal interphalangeal joint was 34°. Recurrence occurred in two patients: one had a minor nodule and the other a natatory cord, which did not result in the redevelopment of a contracture. This study supports the use of dermofasciectomy for the treatment of recurrent Dupuytren’s disease, as well as for the treatment of primary disease in those patients with a strong Dupuytren’s diathesis in this population.

The Proximal Interphalangeal Joint in Dupuytren’s Disease

1985 ◽  
Vol 10 (3) ◽  
pp. 358-364
Author(s):  
M. A. TONKIN ◽  
F. D. BURKE ◽  
J. P. W. VARIAN
Keyword(s):  
Surgical Approach ◽  
Proximal Phalanx ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Contracture ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Average Percentage ◽  
Percentage Improvement

In one hundred patients with Dupuytren’s disease, one hundred and fifty-four operations were performed. The average pre-operative proximal interphalangeal joint contracture was 42° and the average percentage improvement in proximal interphalangeal joint extension at post­operative review was 41%. Fourteen amputations were performed (9.1%). The primary deformity is caused by disease involvement of the palmar fascial structures. Secondary changes may prevent correction of the deformity despite excision of the contracted fascia. The anatomy of the joint is reviewed together with the primary and secondary mechanisms of joint contracture in Dupuytren's disease. Arthrodesis, osteotomy of the proximal phalanx and joint replacement are considered as alternatives to amputation when a systematic surgical approach fails to correct the flexion contracture.

Dupuytren’s Disease Following Acute Injury in Japanese Patients: Dupuytren’s Disease or Not?

2007 ◽  
Vol 32 (5) ◽  
pp. 569-572 ◽  
Author(s):  
Y. ABE ◽  
T. ROKKAKU ◽  
T. EBATA ◽  
S. TOKUNAGA ◽  
T. YAMADA
Keyword(s):  
Diabetes Mellitus ◽  
Elective Surgery ◽  
Middle Finger ◽  
Japanese Patients ◽  
Flexion Contracture ◽  
Dupuytren’S Disease ◽  
Acute Injury ◽  
Separate Entity ◽  
Dupuytren's Disease ◽  
Age And Sex

This paper reports the development of Dupuytren’s disease following acute injury in 16 hands in 14 Japanese patients. The patients included six women and eight men. Five patients developed disease following trauma, one following infection and eight following elective surgery. In the present series, the patient age and sex are irrelevant. The disease was unilateral, confined to a single digital ray, and without ectopic lesions in most cases. Disease presented predominantly in the ring or middle finger rays. There were only three patients who underwent surgery for definite flexion contracture. Diabetes mellitus was the most frequently associated risk factor. Our results suggest that Dupuytren’s disease following acute injury could be considered a separate entity from typical Dupuytren’s disease. At present, we believe that this condition should be considered a subtype of Dupuytren’s disease.

The Lateral Digital Flap for Dupuytren’s Fasciectomy at the Proximal Interphalangeal Joint – a Study of 84 Consecutive Patients

2009 ◽  
Vol 34 (1) ◽  
pp. 90-93 ◽  
Author(s):  
M. U. ANWAR ◽  
S. K. AL GHAZAL ◽  
R. S. BOOME
Keyword(s):  
Skin Graft ◽  
Severe Disease ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Joint Involvement ◽  
Stable Operation ◽  
Transposition Flap ◽  
Dupuytren's Disease ◽  
Direct Closure

Fasciectomy is the most common operation performed for Dupuytren’s disease. However, as the joint contracture increases, issues of skin deficiency following release become significant. For severe or recurrent disease dermafasciectomy is advised, but a digital transposition flap provides a viable alternative without the need for a skin graft for less-severe disease with moderate skin deficiency. A retrospective review identified 84 patients who had undergone this operation. The flap used was proximally based on the midlateral aspect of the finger allowing direct closure of the donor site. Ninety hands with 134 digits were operated on and 83% of the patients had a full correction. About 70% remained fully corrected at 1 year. All flaps were performed for proximal interphalangeal joint involvement. The mean pre-operative contracture was 34°, corrected postoperatively to 5°. The recurrence rate was 9%. Two percent of the patients had local infection but no flap necrosis was seen. A lateral digital transposition flap is a very stable operation for Dupuytren’s disease with moderate skin deficiency and our patients achieved favourable results when compared to other studies that used local flaps combined with skin graft.

Surgery for Dupuytren’s Disease in Japanese Patients and a New Preoperative Classification

2004 ◽  
Vol 29 (3) ◽  
pp. 233-237 ◽  
Author(s):  
Y. ABE ◽  
T. ROKKAKU ◽  
S. OFUCHI ◽  
S. TOKUNAGA ◽  
K. TAKAHASHI ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Surgical Planning ◽  
Japanese Patients ◽  
Proximal Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
New Classification ◽  
Dupuytren's Disease ◽  
Factors Associated ◽  
Percentage Improvement

The surgical outcome of Dupuytren’s disease was evaluated in 73 hands of 57 patients in a Japanese population. Subtotal fasciectomy was performed in all cases. Surgical results were evaluated using the percentage improvement of extension in each finger joint. Statistical analyses were performed on the risk factors associated with recurrence and extension. The surgical outcome depended on the degree of contracture of the proximal interphalangeal joint. Recurrence of disease occurred in eight patients (14%) and extension occurred in nine (16%). Recurrence and extension frequently occurred in those who had ectopic lesions or involvement of the radial side of the hand. The present results suggested that the Dupuytren’s diathesis had an influence on recurrence and extension. We proposed a new classification of Dupuytren’s disease that might help to predict the surgical outcome and facilitate surgical planning.

Angular correction related to excision of specific cords in fasciectomy for Dupuytren’s disease

2013 ◽  
Vol 39 (5) ◽  
pp. 472-476 ◽  
Author(s):  
R. W. Trickett ◽  
R. Savage ◽  
A. J. Logan
Keyword(s):  
Joint Angle ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Flexion Deformity ◽  
Collateral Ligament ◽  
Dupuytren's Disease ◽  
Lateral Cord ◽  
Angular Correction

Named cords were excised sequentially at fasciectomy for Dupuytren’s disease and the resultant correction in the joint angle was measured intra-operatively in 99 fingers. Eighty-two metacarpophalangeal and 59 proximal interphalangeal joints were affected. At the metacarpophalangeal joint, excision of the central cord resulted in 82% correction in 69 joints, and spiral/lateral cord excision resulted in an additional 12% correction in 10 joints. At the proximal interphalangeal joint, excision of the central cord resulted in 44% correction in 36 joints, spiral/lateral cord excision resulted in an additional 19% correction in 16 joints, and retrovascular cord excision resulted in a further 23% correction in 27 joints. Subsequent division of the accessory collateral ligament resulted in a further 14% correction in 14 joints. Larger pre-operative angles of the proximal interphalangeal joint were associated with a retrovascular cord, and larger combined angles were associated with an increasing number of pathological structures involved. The data explain the complexity of surgery at the proximal interphalangeal joint, where four structures are implicated in causing flexion deformity.

Dupuytren’s Disease of the Foot

1980 ◽  
Vol 66 (1) ◽  
pp. 53-55
Author(s):  
P. H. Gibson
Keyword(s):  
Skin Graft ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease

AbstractBased on a series of eight cases the incidence of Dupuytren’s disease of the foot is discussed and treatment by excision and primary skin graft is described.

Intramuscular Tenotomy of Flexor Digitorum Superficialis in the Distal Forearm After Surgical Excision of Dupuytren’s Disease

2003 ◽  
Vol 28 (1) ◽  
pp. 37-39 ◽  
Author(s):  
V. BARR ◽  
R. BHATIA ◽  
P. HAWKINS ◽  
R. SAVAGE
Keyword(s):  
Surgical Excision ◽  
Proximal Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Distal Forearm ◽  
Flexor Digitorum Superficialis ◽  
Dupuytren's Disease ◽  
Postoperative Therapy ◽  
Finger Extension ◽  
Flexor Digitorum ◽  
Loss Of Strength

Contracture of the proximal interphalangeal joint after surgery to excise Dupuytren’s disease, despite release of the contributory structures within the finger, can be caused by flexor digitorum superficialis (FDS) contracture. We describe five cases where FDS contracture was released by intramuscular tenotomy in the distal forearm. Standard postoperative therapy for Dupuytren’s fasciectomy was used and clinical review showed improved finger extension with no loss of strength. We suggest that intramuscular tenotomy of FDS in the forearm can be used safely where indicated after excision of the Dupuytren’s disease.

Cleland’s ligaments and Dupuytren’s disease

2013 ◽  
Vol 39 (5) ◽  
pp. 477-481 ◽  
Author(s):  
D. J. Shewring ◽  
U. Rethnam
Keyword(s):  
Histological Analysis ◽  
Residual Disease ◽  
Flexion Contracture ◽  
Joint Contracture ◽  
Dupuytren’S Disease ◽  
Histological Findings ◽  
Dupuytren's Disease ◽  
Pip Joint ◽  
Joint Flexion ◽  
Neurovascular Bundles

The aim of this study was to investigate whether Cleland’s ligaments are affected by Dupuytren’s disease and assess their contribution to the flexion contracture of the proximal interphalangeal (PIP) joint. Twenty patients with Dupuytren’s disease undergoing fasciectomy for a PIP joint contracture > 40° (mean 61°, range 45°–100°) were included. After excision of all other identifiable digital disease, Cleland’s ligaments were assessed. If they appeared to be macroscopically affected by Dupuytren’s disease they were excised, sent for histological analysis, and any further improvement of PIP joint contracture was recorded. There were 14 males and six females with a mean age of 62 (range 40–79) years. Excision of Cleland’s ligaments resulted in a mean further correction of 7° (range 0°–15°). Histological analysis indicated that Cleland’s ligament was clearly involved with Dupuytren’s disease in 12 patients, indicating that Cleland’s ligaments can be affected by Dupuytren’s disease. In the remaining specimens the histological findings were equivocal. As these structures are situated dorsal to the neurovascular bundles, a specific dissection has to be undertaken to identify them. Excision of Cleland’s ligaments at digital fasciectomy further avoids leaving residual disease and may yield a worthwhile further correction of PIP joint flexion contracture.

Sign in / Sign up

Export Citation Format

Share Document