Dupuytren's Disease of Ring and Little Finger

ObJective Resection of fibrous digitopalmar connective tissues to improve finger function. Indications Dupuytren's disease in Tubiana's stage > III. Partial fasciectomy: at any age, for localized involvement, unlimited degree of contracture, and for recurrences. Complete fasciectomy: extension lag < 45 ° of an individual finger, favorable skin condition, and progressing Dupuytren's disease. Contraindications Poor general health. State after stroke. Infection or eczema of hand. Excessive alcohol intake. Uncooperative patient. Relative: HIV infection. Surgical Technique Antegrade dissection of the fibrous tissue from palm to distal interphalangealjoint through a Y-shaped palmar incision or longitudinal digital incision interrupted by Zplasties at the level of flexion creases. Dissection starts at the radial healthy side. For partial fasciectomy, the fibrous tissue is removed including a safety margin. During complete fasciectomy, the entire triangular palmar fascia including the vertical septae is excised. The so-called open palm technique is a particular form of a partial fasciectomy whereby transverse incisions are not closed as opposed to longitudinal incisions which are always sutured. Results In a prospective study, 48/239 patients were followed up > 2 years. Recurrence rate was 39.7% while hand function improved by 70-86% in ulnar type. Complications observed in a retrospective study (1982-1991) of 566 patients (two thirds partial, one third complete fasciectomy): wound healing disturbance 3%, hematoma 2.5%, vessel injury 1.2%, nerve injury 1.8%, infection 0.7%, persisting edema 0.7%, scar contracture o.2%. 87% of all recurrences appeared within 24 months. Their incidence after 2-1o years varied after partial or complete fasciectomy between 12.5 and 66%, and 21.4 and 39.7 %, respectively. Only a small percentage of these needed a revision.