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Short-Term Results of Surgery for Dupuytren's Disease
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Posted on: 07/12/2006
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Patients with Dupuytren's disease are often have surgery to release tight fascia, the connective tissue in the hand. The operation has changed over the years. In this study surgeons compare the short-term results of a limited fasciectomy (LF) to a percutaneous needle fasciotomy (PNF).
Dupuytren's is an abnormal thickening of the fascia in the palm of the hand. Shortening of this tissue causes "bands" or "cords" that pull the fingers into the palm. Without surgery to release the tissue, the fingers will get stuck in a flexed or bent position in the palm. The fingers can no longer be straightened or extended all the way. This is called a flexion contracture.
Limited fasciectomy is a partial removal of the fascia. The procedure is usually done under a general anesthesia. Only the diseased fascia is taken out. Fasciotomy cuts the bands to relieve tension or pressure. The surgeon uses small incisions in the palm to do this while the patient is awake but the hand is numb.
Two groups of patients with Dupuytren's were treated either with LF or PNF. Results were measured at one and six weeks after the operation. Motion, recovery of function, and patient satisfaction were used as measures of outcome. Complication rate was also compared. Flexion contracture was a sign of failure. The severity of the contracture was measured by the total passive extension deficit (TPED). This is a measure of how much the finger(s) could be straightened by someone else or by using the other hand.
There were no complications after PNF but five percent with the LF. Patient satisfaction was about the same in both groups although the PNF group had less discomfort and better function at the end of both one and six weeks. They were able to use the hand in one week. The main measure of success (TPED) was better in the LF group.
The overall results of this study show that LF is better than PNF. The authors recommend using the PNF method of surgery for mild to moderate cases of Dupuytren's when quick recovery is the goal. The patients in this study will be followed long-term (five years) and final results reported in the future.
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References:
Annet L. van Rijssen, MD, et al. A Comparison of Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren's Disease: A 6-Week Follow-Up Study. In The Journal of Hand Surgery. May-June 2006. Vol. 31A. No. 5. Pp. 717-725.
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