Is Pathological Cord Resection Necessary For Dupuytren Contracture Surgery?
Yuichi Hirase, MD1; Kohei Inami, MD2; Satoshi Usami, MD, PhD2
1Hand Surgery and Microsurgery Center, Yotsuya Medical Cube, Tokyo JAPAN, Japan; 2Takatsuki Orthopedic Surgery Hospital, Tokyo, Japan
Purpose: It is common practice in Dupuytren contracture surgery not to correct the contracture in the fully extended position. This is because Dupuytren contracture patients with flexion contractures often have skin defects on the palm or palmar side of the fingers. If the skin defect is not covered in any way and direct suture closure is performed, postoperative scar recontraction is likely to occur. However, even in cases of Dupuytren contracture with severe flexion deformity, the authors have aggressively used local skin flaps to close the contracture with the goal of full extension of the finger at the end of surgery. Resection of the pathological cord is not a requirement.
Methods: The authors performed Dupuytren contracture surgery in 133 cases, and skin flaps were required for wound closure in 48 cases. In the beginning, the pathological cord was completely resected and the resulting skin defect was covered with local skin flaps, but recently the pathological cord has been completely separated but not resected, and skin flaps have been inserted to break up the pathological cord and release the contracture. The skin flaps used were digitolateral flaps for skin defects on the palmar side of the PIP joint and the base of finger, an ulna para-metacarpal flap for skin defects on the palm.
Results: All skin flaps made were taken completely. Active finger movement was allowed immediately after surgery. In all cases, range of motion of the fingers was remarkably improved, and no cases of recurrence of contracture due to pathological cords were observed after more than 12 months.
Conclusion: Contractures in cases of Dupuytren contracture occur in the direction of the long finger axis. Resection of the pathological cord is not necessary, and if it can be completely seperated, insertion of skin flaps can reduce recurrence.
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