Dupuytren’s disease of ring and little finger
Tóm tắt
Resection of fibrous digitopalmar connective tissues to improve finger function. 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. Poor general health. State after stroke. Infection or eczema of hand. Excessive alcohol intake. Uncooperative patient. Relative: HIV infection. Antegrade dissection of the fibrous tissue from palm to distal interphalangeal joint through a Y-shaped palmar incision or longitudinal digital incision interrupted by Z-plasties 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. 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 0.2%. 87% of all recurrences appeared within 24 months. Their incidence after 2–10 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.
Tài liệu tham khảo
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