Skin Closure After Subtotal Aponeurectomy in Severe Dupuytren’s Contracture: Review

Abstract

Introduction. One of the significant problems of surgical treatment of Dupuytren's contracture is a deficiency of the skin as a result of suturing the wound after subtotal aponeurectomy. The size of the defect depends on the severity of the pathology. In the early stages of the disease, Z-plasty is widely used, but this method of plastic replacement does not completely cover the defect formed after surgical treatment of contracture of III-IV severity, especially when several fingers of the hand are lesioned.
 The purpose of the study. The purpose of the review is a comparative analysis of methods of plastic replacement of skin deficiency after subtotal aponeurectomy in patients with III-IV degree of severity of Dupuytren's contracture.
 Various tactics of treatment of this category of patients are described, including distraction elimination of contracture and further aponeurectomy, as well as various methods of plastic replacement of skin defects formed after resection of altered areas of palmar aponeurosis and elimination of contracture. Each of the proposed methods of surgical treatment has its advantages and disadvantages.
 Conclusions. An analysis of the relevant scientific literature has shown that the most common method of eliminating soft tissue deficiency after aponeurectomy is Z-plasty. However, due to an increase in the severity of the disease, its effectiveness decreases. To date, there is no consensus regarding the approach to the altered site of aponeurosis and there is no single method for eliminating tissue deficiency in the III-IV degree of the disease.