Percutaneous Aponeurotomy and Lipofilling versus Limited Fasciectomy for Dupuytren’s Contracture

The authors have used the open palm and digit technique for Dupuytren’s contracture in fifty-four patients since May, 1973. The procedure consists in making transverse skin incisions on the palm and fingers leaving the wounds open after limited fasciectomy. The results have been surprisingly good due to the elimination of haematoma formation and finger oedema, and the excellent quality of the final scar.

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Dupuytren’s interventions surgery versus collagenase (DISC) trial: study protocol for a pragmatic, two-arm parallel-group, non-inferiority randomised controlled trial

Trials ◽

10.1186/s13063-021-05595-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Joseph Dias ◽

Catherine Arundel ◽

Puvan Tharmanathan ◽

Ada Keding ◽

Charlie Welch ◽

...

Keyword(s):

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Secondary Outcome ◽

Dupuytren’S Contracture ◽

Dupuytren's Contracture ◽

Parallel Group ◽

Collagenase Injection ◽

Randomised Controlled ◽

Limited Fasciectomy

Abstract Background Dupuytren’s contracture is a fibro-proliferative disease of the hands affecting over 2 million UK adults, particularly the white, male population. Surgery is the traditional treatment; however, recent studies have indicated that an alternative to surgery—collagenase clostridium histolyticum (collagenase)—is better than a placebo in the treatment of Dupuytren’s contracture. There is however no robust randomised controlled trial that provides a definitive answer on the clinical effectiveness of collagenase compared with limited fasciectomy surgery. Dupuytren’s intervention surgery vs collagenase trial (DISC) trial was therefore designed to fill this evidence gap. Methods/design The DISC trial is a multi-centre pragmatic two-arm parallel-group, randomised controlled trial. Participants will be assigned 1:1 to receive either collagenase injection or surgery (limited fasciectomy). We aim to recruit 710 adult participants with Dupuytren’s contracture. Potential participants will be identified in primary and secondary care, screened by a delegated clinician and if eligible and consenting, baseline data will be collected and randomisation completed. The primary outcome will be the self-reported patient evaluation measure assessed 1 year after treatment. Secondary outcome measures include the Unité Rhumatologique des Affections de la Main Scale, the Michigan Hand Questionnaire, EQ-5D-5L, resource use, further procedures, complications, recurrence, total active movement and extension deficit, and time to return to function. Given the limited evidence comparing recurrence rates following collagenase injection and limited fasciectomy, and the importance of a return to function as soon as possible for patients, the associated measures for each will be prioritised to allow treatment effectiveness in the context of these key elements to be assessed. An economic evaluation will assess the cost-effectiveness of treatments, and a qualitative sub-study will assess participants’ experiences and preferences of the treatments. Discussion The DISC trial is the first randomised controlled trial, to our knowledge, to investigate the clinical and cost-effectiveness of collagenase compared to limited fasciectomy surgery for patients with Dupuytren’s contracture. Trial registration Clinical.Trials.gov ISRCTN18254597. Registered on April 11, 2017.

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Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren’s Contracture

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000002224 ◽

2016 ◽

Vol 137 (6) ◽

pp. 1800-1812 ◽

Cited By ~ 26

Author(s):

Hester J. Kan ◽

Ruud W. Selles ◽

Christianne A. van Nieuwenhoven ◽

Chao Zhou ◽

Roger K. Khouri ◽

...

Keyword(s):

Dupuytren’S Contracture ◽

Dupuytren's Contracture ◽

Limited Fasciectomy

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Treatment of Dupuytren’s contracture

The Bone & Joint Journal ◽

10.1302/0301-620x.100b9.bjj-2017-1194.r2 ◽

2018 ◽

Vol 100-B (9) ◽

pp. 1138-1145 ◽

Cited By ~ 14

Author(s):

E. Soreide ◽

M. H. Murad ◽

J. M. Denbeigh ◽

E. A. Lewallen ◽

A. Dudakovic ◽

...

Keyword(s):

Adverse Events ◽

High Rate ◽

Dupuytren’S Contracture ◽

Palmar Fascia ◽

Recurrence Rates ◽

Dupuytren's Contracture ◽

Efficacious Treatment ◽

Tissue Changes ◽

Limited Fasciectomy ◽

Needle Aponeurotomy

Aims Dupuytren’s contracture is a benign, myoproliferative condition affecting the palmar fascia that results in progressive contractures of the fingers. Despite increased knowledge of the cellular and connective tissue changes involved, neither a cure nor an optimum form of treatment exists. The aim of this systematic review was to summarize the best available evidence on the management of this condition. Materials and Methods A comprehensive database search for randomized controlled trials (RCTs) was performed until August 2017. We studied RCTs comparing open fasciectomy with percutaneous needle aponeurotomy (PNA), collagenase clostridium histolyticum (CCH) with placebo, and CCH with PNA, in addition to adjuvant treatments aiming to improve the outcome of open fasciectomy. A total of 20 studies, involving 1584 patients, were included. Results PNA tended to provide higher patient satisfaction with fewer adverse events, but had a higher rate of recurrence compared with limited fasciectomy. Although efficacious, treatment with CCH had notable recurrence rates and a high rate of transient adverse events. Recent comparative studies have shown no difference in clinical outcome between patients treated with PNA and those treated with CCH. Conclusion Currently there remains limited evidence to guide the management of patients with Dupuytren’s contracture. Cite this article: Bone Joint J 2018;100-B:1138–45.

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