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Published in: Archives of Orthopaedic and Trauma Surgery 6/2016

01-06-2016 | Handsurgery

The efficacy of open partial aponeurectomy for recurrent Dupuytren’s contracture

Authors: Christian K. Spies, Peter Hahn, Lars P. Müller, Steffen Löw, Richard M. Sellei, Johannes Oppermann

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2016

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Abstract

Introduction

To evaluate the efficacy of open partial aponeurectomy for recurrent Dupuytren’s contracture.

Methods

Eighteen patients with recurrent Dupuytren’s contracture of 22 fingers were retrospectively assessed with a mean follow-up time of 94 months (range: 70–114 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and subjective outcome (disabilities of the arm, shoulder and hand (DASH) questionnaire).

Surgical technique

Dissection with special regard to former skin incision and expected wound defect. Modified incisions after Bruner (Mini-Bruner incisions) were facilitated. Dissection started at the palm. Fibrous tissue was resected proximally within the palm including vertical fibrotic septae. Direct preparation of the neurovascular bundles (NVB) was facilitated from proximal to distal. If the anatomy of the neurovascular structures became unclear around the natatory ligament preparation of the NVB at the distal end of the fibrous cord was performed. After complete preparation of a NVB, dissection was continued from medial to lateral until the other bundle was completely released. Transposition flaps and skin transplants were often used for sufficient wound closure.

Results

Recurrence rate was 36 % applying the definition of van Rijssen et al. Fifteen patients had a grip strength of 90 % or higher in comparison to the contralateral side. Ten patients had a pinch strength of 90 % or higher in comparison to the contralateral side. All patients except for one had pain reduction or none postoperatively. Fifteen patients had a DASH score of 15 or lower (range: 0–47). An unrelated ray amputation was suffered due to wound healing complications.

Conclusions

Open partial aponeurectomy performed by a board certified hand surgeon proved to be safe. The postoperative functional outcome seemed to be related to the individual course of the disease.
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Metadata
Title
The efficacy of open partial aponeurectomy for recurrent Dupuytren’s contracture
Authors
Christian K. Spies
Peter Hahn
Lars P. Müller
Steffen Löw
Richard M. Sellei
Johannes Oppermann
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 6/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-016-2448-2

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