[The lateral-dorsal transposition flap for closure of a palmar soft tissue defect of the proximal phalanx on the little finger after limited fasciectomy in recurrent Dupuytren's contracture].

OBJECTIVE

Closure of a palmar soft tissue defect of the proximal phalanx after limited fasciectomy in recurrent Dupuytren's contracture.

INDICATIONS

A palmar soft tissue defect between the distal flexion crease of the palm and the flexion crease of the proximal interphalangeal joint (PIP) after limited fasciectomy in Dupuytren's contracture.

CONTRAINDICATIONS

Scars at the lateral-dorsal portion of the proximal phalanx (e.g., after burns).

SURGICAL TECHNIQUE

Modified incision after Bruner ("mini-Bruner"). Removal of the involved fascial cord. If necessary, arthrolysis of the PIP. Raising the lateral-dorsal transposition flap from distal to proximal and rotating it into the palmar soft tissue defect of the proximal phalanx. Closure of the donor site with a skin transplant.

POSTOPERATIVE MANAGEMENT

Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days. Afterwards static dorsal splint and daily physiotherapy.

RESULTS

Between 2002 and 2007, a total of 32 lateral-dorsal transposition flaps in 30 patients with recurrent Dupuytren's disease of the little finger underwent surgery. In a retrospective study, 19 patients with 20 flaps were available for follow-up evaluation after a mean of 6 years. All flaps had healed. The median flexion contracture of the metacarpophalangeal joint was 0° (preoperatively, 20°), and of the PIP 20° (preoperatively, 85°) according to Tubiana stage 1 (preoperatively, Tubiana stage 3). The median grip strength of both the operated and the contralateral hand was 39 kg. The DASH score averaged 11 points. Overall, 11 patients were very satisfied, 6 patients were satisfied, 1 patient was less satisfied, and 1 patient was unsatisfied.