Surgical management of Dupuytren’s disease

Abstract

Introduction. Dupuytren's disease (M 72.0) is a fibroproliferative disorder, a disease of the conjuctive system of unknown etiology, which often leads to shortening and thickening of the palmar and digital fascia, to a permanent and irreversible flexion of the fingers. Dupuytren's contracture mainly affects the ring finger and pinky, and occurs most often in older men of Northern European descent. Aim of the study. The retrospective and prospective analysis of the surgical treatment results of MD through various surgical methods. Materials and methods. During 2013-2017, in department of Hand Surgery with the application of microsurgical techniques in Clinical Hospital of Traumatology and Orthopedics, at 426 patients (361 (84.7%) men and 65 (15.2%) women) Dupuytren's disease was diagnosed and treated with different surgical techniques. The mean age for men was 57.3 years and for women 59.6 years, mean age for both - 58.5 years. Urban patients - 156 (36.7%), rural - 270 (63.3%). The number of patients that had their right hand operated was 246 (57.7%) and the left hand - 180 (42.3%). The most commonly affected finger was finger IV – 129 patients (51.19%); finger V - 92 patients (36.51%); III - 22 (8.73%); I - 8 (3.17%); II - 1 (0.4%). III degree of Dupuytren disease was found in 343 (81%) patients, II degree at 60 (14%) and IV degree in 23 (5.4%) patients. In most cases (289 patients) selective excision of palmar aponeurosis with Z-plasty was performed; in 37 cases percutaneous needle aponeurotomy (PNA) was performed; in 13 patients - the open palm technique (from Mc Cash 1964); in 12 patients - cross finger skin flap; in 3 cases - radial forearm flap and in 2 cases – the amputation of pinky finger Results. In order to evaluate the patient's condition and the function of the pre- and postoperative upper limb the DASH subjective inquiry "Disability of the Arm, Shoulder and Hand Outcome Measure" was used. Conclusions. Regardless of the successes in the treatment of orthopedic diseases and experience in the treatment of the serious forms of Dupuytren diseas, the issue of the treatment of these patients remains current. Surgical treatment can correct contractions, but the issue of recurrences and enlargements of the disease remains unresolved.