RESULTS OF TOTAL APONEURECTOMY FOR DUPUYTREN’S CONTRACTURE IN 61 PATIENTS: A RETROSPECTIVE CLINICAL STUDY.

Abstract

Introduction: Dupuytren’s contracture is a common disease in Northern Europe. Partial fasciectomy is often used to treat the whole spectrum of Dupyutren’s disease, although high recurrence rates have been reported. In our department, the majority of patients are treated by total aponeurectomy, which is defined as the complete removal of palmar tissue. It has been found out that apparently normal-looking aponeurosis can also contain an increased proportion of collagen, which may lead to recurrent disease. Consequently, the perceived advantage of total aponeurectomy over partial aponeurectomy is the potential for a lower recurrence rate as all diseased tissue is potentially removed. Against this background, we have reviewed the effectiveness of total aponeurectomy performed on 61 patients.

Patients and Methods: The group of patients available for review consisted of 51 men and ten women with a mean age of 63.0 (range 42–79 years) and with a mean period of 3.45 years (range 1.03–6.39 years) between operation and review. No patient had follow-up of less than 1 year. At follow-up evaluation hands were examined for nodules, cords and retractions of the skin. The active mobility of the joints was determined with a goniometer and the Jamar hand dynamometer was used to measure grip strength in both hands. Sensitivity was examined by means of two-point-discrimination and the DASH-score was used for the analysis of rehabilitation. Patients were also asked about common risk factors for Dupuytren’s disease.

Results: Post-operative complications including haematoma, seroma or necrosis were found in 13.8% of the patients. Recurrence of contracture occurred in 10.8% of the patients and 4.6% of the operated patients presented with a nerve lesion. Nerve irritation was found in 6.2% of the patients. The mean DASH-score was 3.85 (range 0–52.5). Family pre-disposition was an important risk factor for Dupuytren’s disease with 44.3% of patients having a positive family history.

Conclusion: We suggest that total aponeurectomy is a promising alternative to partial fasciectomy with low risk for recurrent disease and slightly increased risk for a nerve lesion.