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Post-operative Management of Dupuytren's Disease with Topical Nitroglycerin
Russell E. Kling, BA1; Patrick I. Emelife, BA1; Ronit Wollstein, MD2; (1)University of Pittsburgh, (2)University of Pittsburgh Medical Center
University of Pittsburgh, Pittsburgh, PA, USA

Introduction:Dupuytren's contracture remains a clinical challenge with significant complications, including scar formation post-surgery, and a recurrence rate of up to 60%. Etiologically, Dupuytren’s contracture may involve local ischemia leading to scar formation in an abnormal distribution. The relation of this disease to diabetes, liver disease, smoking, and hydantoin anticonvulsants supports this theory as these conditions affect the peripheral nervous system and palmar circulation. Local ischemia may also explain the tendency of Dupuytren’s disease to manifest or worsen subsequent to trauma. We used topical nitroglycerin postoperatively to prevent scar recurrence through prevention of local ischemia.

Methods:This was a retrospective case series. All subjects were treated at the VAPHS by the senior author.

Results:The average patient age was 58.7 years. Subjects presented with unilateral symptomatic Dupuytren’s disease. Fasciectomies were performed in all of the patients. Following suture removal, patients received a splint and daily topical nitroglycerin. In these patients, the cream prevented raised scar formation during healing. Average follow time is 18.9 months. To date, there has been no recurrence in the ipsilateral hand and patients report better healing while using the topical nitroglycerin compared with previous surgeries and/or management options.

Discussion: In this series, nitropaste use seemed to prevent recurrent scar formation.

To our knowledge, there is no literature citing the use of topical nitroglycerine post-operatively in cases of Dupuytren's contracture.

Conclusion:Due to its vasodilatory properties, topical nitroglycerin may improve management of patients with Dupuytren’s disease following surgery through prevention of local ischemia.

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