Evaluation of treatment results of patients with Dupuytren's contracture--our clinical experience.

Dupuytren's contracture is a common condition leading to impairment of the function of the hand which affects from 2 to 12 % of the population, mainly males, and presents as progressive contracture of fingers caused by shortening of the palmar aponeurosis. The objective of the work was to present our own approach to managing Dupuytren's disease and evaluate treatment results in patients with hypertrophy of the palmar aponeurosis. Material and method 288 patients with Dupuytren's disease were treated at the Plastic Surgery Hospital in Polanica Zdroj over a period of 25 years (1977-2002). The present paper is a retrospective analysis of treatment results in 253 patients for whom complete medical documentation was available. All patients were operated in local anaesthesia in ischemia. A Bunnell flap skin incision was followed by a fasciectomy of the hypertrophied segment of the palmar aponeurosis. The skin wound was closed using V-Y plasty. Postoperative management involved hand elevation and early rehabilitation. Results Restoration of the full range of motion and total extension in the MP joint and the interphalangeal joints were achieved in 70% and 68% of patients, respectively. Of 145 patients who were professionally active, 132 were able to return to work. Finger amputation was necessary in 2 patients, one patient suffered from arthrodesis and two other developed skin necrosis which was removed with the wound closed by skin grafts. A follow-up examination 6 months after the operation revealed a recurrence in 8 patients and deterioration of hand dexterity with finger stiffness in 4. Conclusions A low complication rate and good treatment results are arguments in favour of the approach adopted at our hospital, i.e. surgery in local anaesthesia in ischemia with compressive bandaging, using a Bunnell flap skin incision followed by radical fasciectomy and V-Y plasty.