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Six Months Postoperative Results of an RCT Comparing Extensive Percutaneous Release and Lipografting with Conventional Fasciectomy in Dupuytren's Disease
Hester J. Kan, MSc1; Ruud W. Selles, PhD1; Christianne A. van Nieuwenhoven, MD, PhD1; Erik T. Walbeehm, MD, PhD1; Roger K. Khouri, MD2; Steven E.R. Hovius, MD, PhD1
1Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, Rotterdam, Netherlands, 2Miami Hand Center, Miami, FL
Purpose: In collaboration with the Miami Hand Center , we recently introduced a novel procedure including extensive percutaneous aponeurotomy combined with lipografting (EPAL) for correcting contracture in Dupuytren’s disease (DD). The design and results after 2 weeks and 6 months from a single-blind multicentre randomized controlled trial comparing EPAL with conventional regional fasciectomy are presented.
Methods: This ongoing study is being conducted at two hospitals in Rotterdam , Erasmus University Hospital (Erasmus MC) and Sint Franciscus Gasthuis. In total, 80 patients were included in this study. All patients with a follow-up of at least six months were included for this abstract. Fifty-three patients suffering from primary DD who have been randomly assigned to the EPAL (n= 33) or fasciectomy (n= 20) group could be included in the present analysis.
To blind the examiners, the patients wore blue latex gloves. We analyzed the contracture correction by measuring the total passive extension (MCP+PIP+DIP) deficit preoperative and at 2 weeks and 6 months after surgery and estimated convalescence by calculating the total flexion angle (MCP+PIP+DIP) and diary questionnaires. We also scored complications for each group.
Results: Total passive extension deficits (TPED) were similar in the groups at two weeks follow-up (EPAL 17°±18° versus fasciectomy 10°±12°, p=0.125). The total flexion angle at two weeks was significantly larger (p=0.008) in the EPAL group (226°±40°) than in the fasciectomy group (188°±52°).
The increase in TPED between two weeks and six months postoperatively was comparable for the EPAL group and the fasciectomy group (EPAL 11°±22° versus fasciectomy 5°±8°, p=0.213). The total flexion angle for both groups was the same at six months (EPAL 241°±26° versus fasciectomy 245°±33°, p=0.621).
The time needed to return to daily activity was shorter in the EPAL group (3±4 weeks) then the fasciectomy group (7±13 weeks), although not significant (p=0.208).
Two patients in the EPAL group and one patient in the fasciectomy group suffered from CRPS. One patient in the fasciectomy group had one nerve lesion, and one had an arterial lesion.
Conclusion: Preliminary analyses indicate a similar and successful contracture correction in both groups at two weeks and six months, although the EPAL group obtained a much larger total flexion angle at two weeks. The total flexion angle and time to return to normal daily activity (in weeks) indicate faster recovery for the EPAL group. At six months the total flexion angle in the fasciectomy group was similar to that in the EPAL group.
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