Abstract
Recurrent Dupuytren contracture can be aggressive and prone to further recurrence even with surgical treatment. Recurrence risk is increased further by the presence of Dupuytren diathesis. Surgical fasciectomy allows for subtotal or total excision of the pathological Dupuytren cords and resultant contracture correction in recurrent contracture. Extra care must be taken in revision fasciectomy cases to carefully identify and protect the neurovascular bundles as their anatomy will be distorted by both Dupuytren tissue and scarring from prior surgery. Tension on the neurovascular bundles of the digit may compromise the neurovascular status of the digit in cases of severe contracture and full correction may not be possible. When closure of surgical wounds with Z-plasties alone is not possible, full-thickness skin grafting from the hypothenar eminence provides glabrous, non-hair bearing, durable donor skin that is a good texture match for the volar surfaces of the digits. Though further study on skin grafting following fasciectomy for Dupuytren contracture is needed, skin grafting may provide advantages in decreasing disease recurrence through allowing for resection of skin overlying Dupuytren tissue, which may be involved in the disease process, providing a “firebreak” between proximal and distal disease in a digit, and decreasing tension at the wound site.
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References
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Suggested Readings
Becker GW, Davis TR. The outcome of surgical treatments for primary Dupuytren’s disease—a systematic review. J Hand Surg Eur Vol. 2010;35(8):623–6.
Hindocha S, Stanley JK, Watson S, Bayat A. Dupuytren’s diathesis revisited: evaluation of prognostic indicators for risk of disease recurrence. J Hand Surg. 2006;31(10):1626–34.
Roush TF, Stern PJ. Results following surgery for recurrent Dupuytren’s disease. J Hand Surg. 2000;25(2):291–6.
Roy N, Sharma D, Mirza AH, Fahmy N. Fasciectomy and conservative full thickness skin grafting in Dupuytren’s contracture. The fish technique. Acta Orthop Belg. 2006;72(6):678–82.
Tonkin M, Burke F, Varian J. Dupuytren’s contracture: a comparative study of fasciectomy and dermofasciectomy in one hundred patients. J Hand Surg Br Eur Vol. 1984;9(2):156–62.
Ullah AS, Dias JJ, Bhowal B. Does a ‘firebreak’ full-thickness skin graft prevent recurrence after surgery for Dupuytren's contracture?: a prospective, randomised trial. J Bone Joint Surg. 2009;91(3):374–8.
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Draeger, R.W., Stern, P.J. (2016). Recurrent Dupuytren Contracture Treated with Fasciectomy and Skin Grafting. In: Rizzo, M. (eds) Dupuytren’s Contracture. Springer, Cham. https://doi.org/10.1007/978-3-319-23841-8_19
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DOI: https://doi.org/10.1007/978-3-319-23841-8_19
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