Watson H K, Fong D
Connecticut Combined Hand Service: Hartford Hospital.
Hand Clin. 1991 Nov;7(4):745-55; discussion 757-8.
Postoperative complications can jeopardize the results of surgery. These can be avoided by Y-V plasties that allow for efficient skin "lengthening" and wound healing. Proper dressing techniques can prevent hematoma formation. The patient must be started on early active motion to prevent stiffness, and the physician must monitor for reflex sympathetic dystrophy. If RSD should occur, the dystrophile program is the most effective means of treatment. Fasciectomy alone is not always successful in correcting Dupuytren's contracture, especially in longstanding cases. The surgeon should be prepared to correct other entities such as checkreins, sheath fibrosis, and tendon adhesions. Occasionally, a severely compromised finger is not amenable to correction. In this case, salvage procedures are available, such as the concentric arthrodesis that preserves the length of the volar structures. Only when all other attempts fail should one resort to amputation.
术后并发症可能会危及手术效果。通过Y-V成形术可以避免这些并发症，该手术能够实现有效的皮肤“延长”和伤口愈合。正确的包扎技术可以防止血肿形成。患者必须尽早开始主动活动以防止关节僵硬，医生必须监测反射性交感神经营养不良。如果发生反射性交感神经营养不良，去营养化方案是最有效的治疗方法。单纯的筋膜切除术在矫正杜普伊特伦挛缩时并不总是成功的，尤其是在病程较长的病例中。外科医生应准备好矫正其他病变，如掌腱膜挛缩、腱鞘纤维化和肌腱粘连。偶尔，严重受损的手指无法进行矫正。在这种情况下，可以采用挽救手术，如保留掌侧结构长度的同心关节融合术。只有在所有其他尝试都失败时才应考虑截肢。
