Functional outcome and complications following surgery for Dupuytren’s disease: a multi-centre cross-sectional study

Abstract

Variables associated with recurrent Dupuytren's disease, or a 'diathesis', have been investigated, but those associated with functional outcome and complications are less well studied. Outcomes 1 or 5 years after an aponeurotomy, fasciectomy or dermofasciectomy were assessed by patient interview and examination at five UK centres. A total of 432 procedures were studied. The reoperation rate did not differ at 1 year (p = 0.396, Chisquare test with Monte Carlo simulation), but was higher after aponeurotomy in the 5-year group (30%, versus 6% after fasciectomy and 0% after dermofasciectomy, p = 0.003, Chi square test with Monte Carlo simulation). Loss of function (DASH>15) did not differ between procedures at 5 years, even when reoperation and other variables were controlled. Diabetes, female gender and previous ipsilateral surgery were associated with poorer function in logistic regression analysis. The variables associated with poor function after treatments differ from diathesis variables. Aponeurotomy had lower complication rates than fasciectomy and dermofasciectomy. This may counterbalance the former's higher recurrence rate and explain why aponeurotomy demonstrated similar long-term functional outcome compared with excisional surgery in this study. Level of evidence: III

A systematic review identifying outcomes and outcome measures in Dupuytren’s disease research

“…Eckerdal et al. (2014) and Rodrigues et al. (2017) additionally reported the proportion of patients achieving certain score thresholds.…”

“…Complex regional pain syndrome was queried in 32 studies. The outcome was defined in three studies (Anwar et al., 2007; Rodrigues et al., 2017; Wade et al., 2016), and two of these (Rodrigues et al., 2017; Wade et al., 2016) used the standardized definition developed by the International Association for the Study of Pain (Harden et al., 2007).…”

Risk factors for limited improvement after total trapeziometacarpal joint arthroplasty

“…In CTR the effect of age seems unclear as the results differ in different studies [22,25,27,30,31]. No effect of age has been found in studies on surgical treatment for DRF [23], surgical treatment for Dupuytren's Contracture [32], and open dorsal wrist ganglion excision [28] which makes it hard to determine whether or not age at the time of operation has an effect on hand surgical outcome.…”

Recent advances in the understanding of Dupuytren’s disease

“…The proposed advantage of these techniques is reduced risk of recurrence as compared with minimally invasive procedures such as PNF, together with better correction of flexion deformity 65, 69, 71 . A potential benefit of dermofasciectomy is more radical clearance of the diseased tissue as well as potential myofibroblast precursors in the overlying fat and dermis, and a multi-centre cross-sectional study reported the reoperation rate following fasciectomy as 6% compared with 0% after dermofasciectomy at 5 years 72 . However, residual impairment of hand function did not differ between procedures, even when reoperation and other variables were controlled.…”