Rotterdam, The Netherlands; and Miami, Fla. From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center, and Miami Hand Center.
Plast Reconstr Surg. 2011 Jul;128(1):221-228. doi: 10.1097/PRS.0b013e31821741ba.
Surgical resection of Dupuytren contracture is fraught with morbidity and prolonged recovery. This article introduces a novel minimally invasive alternative for Dupuytren disease and its outcome.
The procedure consists of an extensive percutaneous aponeurotomy that completely disintegrates the cord and separates it from the dermis. Subsequently, the resultant loosened structure is grafted with autologous lipoaspirate. After 1 week of postoperative extension splinting, patients are allowed normal hand use and are advised to use night splints for 3 to 6 months. The authors treated and report on their experience with 91 patients (99 hands) operated on in Miami and Rotterdam; from 50 patients, the authors report on goniometry (average follow-up, 44 weeks).
The contracture from the proximal interphalangeal joint improved significantly from 61 degrees to 27 degrees, and contracture from the metacarpophalangeal joint improved from 37 degrees to -5 degrees. Ninety-four percent of patients returned to normal use of the hand within 2 to 4 weeks and 95 percent were very satisfied with the result. No new scars were added, and a supple palmar fat pad was mostly restored. Complications were digital nerve injury in one patient, postoperative wound infection in one patient, and complex regional pain syndrome in four patients.
This new minimally invasive technique shortens recovery time, adds to the deficient subcutaneous fat, and leads to scarless supple skin. By its ability to treat multiple rays, it addresses the abnormality in the entire hand. The procedure is safe and effective, especially for primary cases. Currently, comparative prospective randomized studies are in process to fully determine its role in the treatment of Dupuytren contracture.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.(Figure is included in full-text article.).
行外科切除术治疗杜普伊特伦挛缩症（Dupuytren contracture）存在较高的发病率和较长的恢复期。本文介绍了一种治疗杜普伊特伦挛缩症的新微创方法及其结果。
该手术包括广泛的经皮腱膜切开术，可完全分解索状结构并将其与真皮分离。随后，将松解后的结构用自体脂肪抽吸物进行移植。术后用伸展夹板固定 1 周，即可允许患者正常使用手部，并建议使用夜间夹板 3 至 6 个月。作者在迈阿密和鹿特丹治疗并报告了 91 例患者（99 只手）的经验；其中 50 例患者报告了关节角度测量结果（平均随访时间为 44 周）。
近指间关节的挛缩从 61 度显著改善至 27 度，掌指关节的挛缩从 37 度改善至 -5 度。94%的患者在 2 至 4 周内手部恢复正常使用，95%的患者对结果非常满意。没有新增疤痕，手掌下的脂肪垫大多得以恢复柔软。并发症包括 1 例患者的指神经损伤、1 例术后伤口感染和 4 例复杂性区域疼痛综合征。
这种新的微创技术缩短了恢复期，增加了皮下脂肪量，使皮肤恢复柔软无疤痕。通过能够治疗多个手指，它可以解决整个手部的异常。该手术安全有效，特别是对于原发性病例。目前，正在进行比较前瞻性随机研究，以充分确定其在治疗杜普伊特伦挛缩症中的作用。
临床问题/证据水平：治疗性，IV 级。（图包含在全文中。）
