REVIEW OF FASCIECTOMY AND CONSERVATIVE FULL THICKNESS SKIN GRAFTING IN DUPUYTREN’S CONTRACTURE- THE FISH TECHNIQUE

Abstract

Full thickness skin grafting has been used following dermo-fasiectomy for Dupuytren’s contracture. We have used a conservative approach following excision of the contracture. Following radical excision through Brunner’s incision, an elliptical full thickness skin graft is harvested from the volar aspect of the wrist. This is applied to the wound on the volar aspect of the proximal phalanx to cover the gap with the finger held in extension. Patients who have undergone primary Dupuytren’s excision between 1990–1998 were recalled and evaluated in special clinic. Clinical notes were reviewed for pre-operative deformity, wound problems if any and recurrence of deformity at annual follow-up. Patients were reviewed for present status of deformity, ROM, sensation, 2-point discrimination, evidence of recurrence and patient satisfaction.

One hundred and six fingers were evaluated in 80 patients. Average duration of follow-up was 52 months. Sixty-five patients had bilateral disease and 29 patients had family history of Dupuytren’s disease. Average pre-operative flexion deformity of the PIP joint was 68.6 degrees and 12 patients had deformity of the DIP joint. Mean flexion deformity at review of the PIP joint was 26.4 degrees. 29 patients reported sensitivity to cold. Two-point discrimination was abnormal in 24 patients. Skin tightness was noted in 8 fingers and 7 cases had recurrence. In 2 fingers the recurrence was away from the graft and in remaining 5 fingers it was proximal to the graft not crossing the grafted area. Thirty-three patients had progressive disease in the adjacent fingers away from the operated area. There was no case of graft loss. Seventy patients were satisfied with the end results of the operation.

Our study has shown a very low incidence of recurrence following radical dissection and similar result as dermo-fasciectomy, and the skin graft acting as a barrier in cases of recurrence. Also graft harvested from the wrist matches the colour of the palm with increased patient satisfaction.