Simultaneous Regional Fasciectomy, Skin Grafting, and Distraction Arthrolysis of the Proximal Interphalangeal Joint for Dupuytren’s Contracture of the Little Finger

Hand Surgery ◽  
2015 ◽  
Vol 20 (02) ◽  
pp. 298-301
Author(s):  
Motohisa Kawakatsu ◽  
Susumu Saito
Keyword(s):  
Skin Grafting ◽  
Proximal Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Skeletal Traction ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Pip Joint ◽  
History Of ◽  
Little Finger

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.

THE PROGNOSIS OF FASCIECTOMY FOR ABDUCTOR DIGITI MINIMI AND PRETENDINOUS CORDS IN DUPUYTREN'S DISEASE OF THE LITTLE FINGER

Hand Surgery ◽  
2009 ◽  
Vol 14 (02n03) ◽  
pp. 89-92 ◽  
Author(s):  
M. J. Walton ◽  
D. Pearson ◽  
D. A. Clark ◽  
R. K. Bhatia
Keyword(s):  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Residual Deformity ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Significant Difference ◽  
Abductor Digiti Minimi ◽  
The Mean ◽  
Recurrent Deformity ◽  
Little Finger

Thirty-nine consecutive patients with little finger Dupuytren's contracture underwent open fasciectomy. Diseased abductor digiti minimi (ADM) pretendinous (PT) cords were identified. The mean pre-operative PIPJ contracture was 77° in the PT group and 66° in the ADM group. Mean residual deformity was 12° in the PT group and 9° in the ADM group. At six months, ten out of 27 patients had developed a recurrent deformity in the PT group (mean 24°) and seven out of 11 in the ADM group (mean 18°). There was no statistically significant difference between the two groups at any stage. Dupuytren's contracture of the little finger is as a result of an ADM cord in 29% of cases. In this series it led to an isolated contracture of the PIPJ in the majority of cases and rarely affected the MCPJ. Disease of the ADM cord was not associated with a difference in contracture or prognosis compared to a PT cord.

scholarly journals Dupuytren’s Contracture with Secondary Ulnar Neuropathy

2020 ◽  
Vol 11 (03) ◽  
pp. 481-483
Author(s):  
Chen Fei Ng
Keyword(s):  
Diabetes Mellitus ◽  
Clinical Symptoms ◽  
Chronic Alcoholism ◽  
Ulnar Neuropathy ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Hand Trauma ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Patients With Diabetes

AbstractDupuytren’s disease is a progressive fibrotic condition of the hand. The underlying pathomechanism is not fully known. Dupuytren’s contracture can be seen in patients with diabetes mellitus, chronic alcoholism, smoking, or hand trauma. It is uncommon to affect the neurovascular supply causing clinical symptoms. We describe a patient with idiopathic Dupuytren’s disease complicated with bilateral ulnar neuropathies and highlight the importance of such rare treatable complication.

An Investigation into the Role of Inflammatory Cells in Dupuytren’s Disease

1991 ◽  
Vol 16 (3) ◽  
pp. 267-271 ◽  
Author(s):  
J. G. ANDREW ◽  
S. M. ANDREW ◽  
A. ASH ◽  
B. TURNER
Keyword(s):  
Inflammatory Cells ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Palmar Fascia ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Microvascular Changes ◽  
Macrophage Marker ◽  
Fibrotic Diseases

An immunohistochemical study was performed on nodules excised from the palmar fascia of patients with Dupuytren’s contracture. In cellular nodules, antibodies to actin (used as a marker for myofibroblasts), desmin, vimentin, Mac 387 (a macrophage marker) and leucocyte common antigen were used. A correlation was demonstrated between the numbers of macrophages and the presence of myofibroblasts. The presence of myofibroblasts is generally considered to indicate the active stage of the disease. Inflammatory cells other than macrophages were largely absent from the nodules, although lymphocytes were frequent in the tissue around the nodules. Microvascular changes were prominent in the nodules and pericyte proliferation was observed around occluded capillaries. Release of growth factors from macrophages may be important in Dupuytren’s contracture, as is the case in other fibrotic diseases. The possible role of macrophages in the aetiology of Dupuytren’s disease is discussed.

The Use of Skeletal Traction to Correct the Flexed PIP Joint in Dupuytren’s Disease

1994 ◽  
Vol 19 (4) ◽  
pp. 534-537 ◽  
Author(s):  
P. D. HODGKINSON
Keyword(s):  
Recurrent Disease ◽  
Flexion Angle ◽  
Simple Device ◽  
Dupuytren’S Disease ◽  
Skeletal Traction ◽  
Dupuytren's Disease ◽  
Pip Joint

The flexed PIP joint presents a particular problem in the treatment of advanced Dupuytren’s disease. Following reports of the use of skeletal traction in the treatment of this condition, a simple device, the “Pipster” was developed to extend the PIP joint by skeletal traction before surgery. In seven fingers in five patients with severe contractures, there was a pre-operative improvement of at least 45° in the flexion angle (measured as maximum achievable passive extension). The technique was effective in primary and recurrent disease. Subsequent surgery was facilitated and amputation avoided in five tigers. The optimum distraction technique was identified. The study continues with more patients.

scholarly journals Finger shortening for Dupuytren’s disease-induced severe PIP joint flexion contracture of the little finger: A report of two cases

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 11
Author(s):  
Yoko Ito ◽  
Kiyohito Naito ◽  
Nana Nagura ◽  
Yoichi Sugiyama ◽  
Hiroyuki Obata ◽  
...  
Keyword(s):  
Daily Living ◽  
Treatment Method ◽  
Flexion Contracture ◽  
Dupuytren’S Disease ◽  
High Patient Satisfaction ◽  
Dupuytren's Disease ◽  
Extended Position ◽  
Pip Joint ◽  
Joint Flexion ◽  
Little Finger

When severe proximal interphalangeal (PIP) joint flexion contracture is induced in the little finger by Dupuytren’s disease, it interferes with activities of daily living. To extend the little finger, open fasciectomy is selected as a general treatment method. However, postoperative complications have been frequently reported. To solve these problems, finger shortening was undertaken. In this study, we treated two cases of Dupuytren’s disease manifesting severe PIP joint flexion contracture of the little finger with finger shortening by proximodistal interphalangeal (PDIP) fusion in which the middle phalanx is resected and the residual distal and proximal phalanges are fused. For flexion contracture of the MP joint, a percutaneous aponeurotomy using an 18G needle was performed to obtain the extended position of the MP joint. Favorable outcomes with high patient satisfaction, including esthetic aspects of retaining the finger with the nail without complication, were achieved. We report this challenging treatment and its discussion.

Boutonniere Deformity in Dupuytren’s Disease

1988 ◽  
Vol 13 (4) ◽  
pp. 379-382
Author(s):  
J. N. KUHLMANN ◽  
A. BOABIGHI ◽  
S. GUERO ◽  
M. MIMOUN ◽  
S. BAUX
Keyword(s):  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Complete Ablation ◽  
Boutonniere Deformity ◽  
Extensor Apparatus ◽  
Boutonnière Deformity

The boutonnière deformity in Dupuytren’s disease has been found to be due to fibrous contraction of the transverse retinacular ligament which anteriorly displaces the fibres of the extensor apparatus. Complete ablation of this ligament and liberation of the extensor apparatus arrows easy extension of the finger when operating on severe cases of Dupuytren’s contracture.

scholarly journals “The Serpentine Zone”: A Surgeon's Guide to the Surface Anatomy of the Digital Neurovascular Spiral in Dupuytren's Contracture

2017 ◽  
Vol 10 (01) ◽  
pp. 054-056
Author(s):  
Alistair Macey ◽  
Roshin Thomas
Keyword(s):  
Neurovascular Bundle ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Surface Anatomy ◽  
Neurovascular Injury

AbstractThe anatomy of the cords that form in Dupuytren's disease is complicated and a spiral cord is the most challenging variant to address. It displaces the neurovascular bundle toward or beyond the midline and closer to the skin. This article illustrates the surface anatomy of the neurovascular spiral to help surgeons identify this zone of danger that the authors term “the serpentine zone.” Careful dissection in this zone will help avoid iatrogenic digital neurovascular injury.

scholarly journals Surgical management of Dupuytren contracture of the ring finger: a case report

2020 ◽  
Vol 8 (4) ◽  
pp. 1570
Author(s):  
Gede Ketut Alit Satria Nugraha ◽  
Made Bramantya Karna ◽  
Gde Dedy Andika ◽  
Made Sunaria
Keyword(s):  
Gold Standard ◽  
Ring Finger ◽  
High Rate ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Disease ◽  
Disease Etiology ◽  
Dupuytren's Contracture ◽  
Scar Assessment

Dupuytren’s disease, also called Dupuytren’s contracture or palmar fibromatosis, is a condition in which the connective tissue under the skin of the palm contracts and toughens over time. The gold standard treatment for Dupuytren’s contracture is surgery. We present a case of Dupuytren’s contracture treated with Bruner incision which resulted in good functional outcome. A 79 year old male presented to our Orthopaedic Clinic RSUP Sanglah Denpasar with the complaints of pain and stiffness on his left ring finger since 5 years ago. Patient had same history with his right hand and had operation 20 years ago. The patient underwent release of contracture using Bruner incision and had no complaint in 6 month follow-up. Extension deficit was <5°, reduction of contracture was >50%, the Patient and Observer Scar Assessment Scale (POSAS) gave overall opinion of the scar being minimal. The Dupuytren's disease etiology remains uncertain, with genetics perceived as most probable factor. Despite short-term success, there is a high rate of recurrent contracture with additional comorbidities such as wound-healing complications and neurovascular injury. In this case, the patient was treated using fasciotomy with Bruner incision and had satisfying outcome. Fasciotomy is known to have less complication in terms of recurrence. Dupuytren disease is characterized by abnormal thickening of the palmar fascia beneath the skin and the gold standard of treatment is surgery. This case presented surgical treatment using Bruner incision which had satisfying outcome in 6 month follow-up.

scholarly journals Limited palmar fasciectomy for bilateral Dupuytren’s contracture

2021 ◽  
Vol 9 (10) ◽  
pp. 3186
Author(s):  
Surya Rao Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj ◽  
Narayanamurthy Sundaramurthy ◽  
Anand Prasath Jayachandiran ◽  
Suresh Rajendran
Keyword(s):  
Surgical Treatment ◽  
Dupuytren’S Disease ◽  
Northern Europe ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Dupuytren Disease

Dupuytren’s disease is a fibro-proliferative condition affecting the palmar and digital fascia. This disease is very common in Northern Europe but in India it uncommon as there are only a few cases reported, hence also called as ‘Viking Disease’. Surgical fasciectomy is the standard surgical treatment of choice for Dupuytren’s disease. Complications following surgery are high but there is no definitive cure for Dupuytren disease (DD), and recurrence of finger contractures after treatment is common.

Cost Comparison of Collagenase Clostridium Histolyticum and Fasciectomy for Treatment of Dupuytren’s Contracture in the Australian Health System

2018 ◽  
Vol 23 (03) ◽  
pp. 336-341 ◽  
Author(s):  
Andrew K. Sefton ◽  
Belinda J. Smith ◽  
David A. Stewart
Keyword(s):  
Treatment Options ◽  
Cost Comparison ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Health Care Environment ◽  
Dupuytren's Disease ◽  
Australian Health ◽  
Dupuytren's Contracture ◽  
Clostridium Histolyticum

Background: Dupuytren’s disease results in contracted cords in the hand that lead to deformity and disability. Current treatment options include fasciectomy and an injectable, collagenase clostridium histolyticum. No cost comparison studies have been published within the Australian health care environment. Methods: A retrospective review of all patients treated for Dupuytren’s disease in a major teaching hospital was undertaken to compare the costs of treatment by fasciectomy or collagenase injection. Results: Eighteen patients underwent fasciectomy and 21 collagenase clostridium histolyticum injections were performed during the study period and were eligible for inclusion under the review criteria. Of the 39 patients, 36 were male and 3 were female with an average age 66.4 years (50–85). Twenty-five digits were treated by fasciectomy in 18 patients, and 23 digits were treated by collagenase in 21 patients. The fasciectomy group attended an average 9.2 visits (5–22), incurring an average costing of US$5738.12 per patient ($3181.18–$9618.10). The collagenase group attended an average 3.8 visits (3–8), incurring an average costing of US$2076.83 per patient ($1842.24–$3929.57). Conclusions: Collagenase treatment of Dupuytren’s contracture represents a significant reduction in cost relative to fasciectomy, with 64% savings, length of follow up and number of visits. This is a similar finding to studies in other countries.

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