Repeat limited fasciectomy is a safe and effective treatment for recurrence of Dupuytren’s disease

Abstract

Aims The results of surgery for Dupuytren’s disease can be compromised by the potential for disease recurrence and loss of function. Selecting which patients will benefit from repeat surgery, when to operate, and what procedure to undertake requires judgement and an understanding of patient expectations and functional needs. We undertook this study to investigate patient outcomes and satisfaction following repeat limited fasciectomy for recurrent Dupuytren’s disease. Methods We prospectively identified all patients presenting with recurrence of Dupuytren’s disease who were selected for surgical treatment with repeat limited fasciectomy surgery between January 2013 and February 2015. Patients were assessed preoperatively, and again at a minimum of five years postoperatively. We identified 43 patients who were carefully selected for repeat fasciectomy involving 54 fingers. Patients with severe or aggressive disease with extensive skin involvement were not included; in our practice, these patients are instead counselled and preferentially treated with dermofasciectomy. The primary outcome measured was change in the Michigan Hand Outcomes Questionnaire (MHQ) score. Secondary outcomes were change in finger range of motion, flexion contracture, Semmes-Weinstein monofilament (SWM) values, and overall satisfaction. Results There was a significant improvement in MHQ scores, across all domains, with a mean overall score increase of 24 points (p < 0.001). The summed flexion contracture across the metacarpophalangeal joint (MCPJ) and the proximal interphalangeal joint (PIPJ) reduced from means of 72.0° (SD 15.9°) to 5.6° (SD 6.8°) (p < 0.001). A significant increase in maximal flexion was seen at the MCPJ (p < 0.001) but not the PIPJ (p = 0.550). The mean overall satisfaction score from the visual analogue scale was 8.9 (7.9 to 10.0). Complications were uncommon although five fingers showed reduced sensibility at final follow-up. Conclusion Our study shows that repeat limited fasciectomy for selected patients presenting with recurrence of Dupuytren’s disease can be an effective and safe treatment resulting in excellent patient-reported outcomes and levels of satisfaction. Cite this article: Bone Joint J 2021;103-B(5):946–950.

Adiponectin inhibits fibrosis of the palmar aponeurosis in Dupuytren’s contracture in male patients

“… 17 Several studies have reported the factors that predict disease development or surgical treatments for Dupuytren’s contracture. 18 , 19 However, its pathogenesis remains unclear. Although the mechanism underlying fibrosis of the palmar aponeurosis has yet to be identified, TGF-β signalling, which plays an important role in fibrosis, has been implicated.…”

Benign Tumors of the Wrist, Hand, and Fingers

“…DF involves removal of fibrous tissue and skin with the application of a full thickness skin graft. Disadvantages of DF include prolonged recovery, skin graft failure, donor sight scarring, higher complication rates, and cosmetic irregularities [14][15][16] .…”

“…Ultrasound images of fibromatosis show hypoechoic nodules/cords originating in the palmar fascia. MRI scanning shows low signal intensity in both T1 and T2 images, characteristic of collagen-dense nodules/cords 15,16 . Treatment options for Dupuytren's disease consists of conservative therapy (physiotherapy, radiation, steroid [oral vs. injections] Clostridium histolyticum collagenase [CCH] and surgical options [percutaneous needle fasciotomy, open fasciotomy [OF], limited fasciectomy [LF], and dermofasciectomy [DF]).…”

“…Ultrasound images of fibromatosis show hypoechoic nodules/cords originating in the palmar fascia. MRI scanning shows low signal intensity in both T1 and T2 images, characteristic of collagendense nodules/cords 15,16 Percutaneous needle fasciectomy is an office-base procedure performed with local anesthetic that provides fast results, can be repeated multiple times but has a high recurrence rate. Open fasciotomy is recommended for patients with functional impermanent of .30 degrees at the MCP joint.…”

Comparing Complications and Patient Satisfaction Following Injectable Collagenase Versus Limited Fasciectomy for Dupuytren’s Disease: A Systematic Review and Meta-Analysis

“…This suggests that both treatment modalities are associated with favorable levels of patient satisfaction. According to Shaw et al, CCH injections are seen to be more effective in mild and moderate disease [ 43 ], unlike LF, which is seen to be more beneficial in aggressive and recurrent disease [ 44 , 45 ].…”