A natural history of Dupuytren's contracture treated by surgical fasciectomy: the influence of diathesis (76 hands reviewed at more than 10 years).

Fifty-six patients (51 males and 5 females) were reviewed more than 10 years after surgical fasciectomy for Dupuytren's disease (average 12 years 7 months). 76 hands were operated upon (20 bilateral cases) for a total of 137 fingers (out of 152 affected digits). The average pre-operative score based on Tubiana's classification was of 4.28. To-date, at maximum follow-up time, it is of 2.45. 34 recurrences occurred before re-operation (i.e. 45%), whereas at maximum follow-up, 74% of hands are still defective, although only 22% cause functional impairment. The method of improvement ratio classifies patients into two categories: satisfactory results and failures. This original method of qualification emphasizes three negative factors: recurrences, initial severity of disease, and failure to achieve full finger extension post-operatively. Results as a whole are in accordance with those mentioned in literature. Improved results depend on early surgery for severe cases, which must therefore be diagnosed at an early stage. Surgery often sets back the disease, without curing it. Further efforts in fundamental research on the etiology of this disease will be needed.