Perforator Flap Based Technique for the Treatment of Dupuytren's Contracture

Abstract

Background: Perforator flap based technique was used in treating Dupuytren’s Contracture in a cohort of 48 patients. This perforator based on the ulnar palmar digital artery originates from the superficial palmar arch and supplies the hypothenar area. Methods: A curved incision that exposes the diseased palmar fascia was made in middle to distal palm lateral to the hypothenar eminence beginning 20mm distal to the distal wrist crease up to the heel of the palm. An additional incision from the arch of the curved incision extends into the middle phalanx for exposure of the digital cord. The perforator flap was raised along the hypothenar region in 53 hands of 48 patients, nine females and 39 males and their ages at the time of surgery averaged 56 years. The Tubiana classification illustrates the extent of the disease in our patients’ population with no distal interphalangeal joint involvement. Results: Of the 48 patients, five patients had bilateral hands involvement. Two patients complained of paresthesia in the ring and little fingers after surgery, the symptom had disappeared without further intervention before the latest follow-up. There was no incidence of skin necrosis and delayed healing. Up to date, there has been no reported recurrence. Conclusion: This perforator flap based technique is technically simple and reliable with better exposure and easier removal of all the diseased fascia, making it possible for primary healing without skin necrosis and acceptable for treatment of patients at all stages of the disease.