Hoang Don, Steven Patrick, Chen Vivi W, Stasiak Ashley, Cohen Myles, Kulber David A
Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
Center for Plastic and Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif.
Plast Reconstr Surg Glob Open. 2019 May 23;7(5):e2263. doi: 10.1097/GOX.0000000000002263. eCollection 2019 May.
Recurrence rates following surgical intervention for Dupuytren's disease (DD) remains high. In this study, we investigate the use of acellular dermal matrix (ADM) to reduce recurrence and improve long-term clinical outcome.
We examined 132 patients undergoing open fasciectomy for DD from 2007 to 2017. The experimental group had a sheet of ADM (FlexHD) sutured into the surgical bed controls were not closed with ADM. Patient characteristics, range of motion, and complications were examined.
Twenty-eight (21.2%) patients were treated with acellular dermal matrix, whereas 104 (78.8%) patients were not. The median age was 67.0 years (range 34-91 years). with no differences between group regarding age, comorbidities, and laterality. The mean preoperative interphalangeal joint flexion contracture in the ADM group of 66.5 ± 29.9 degrees was corrected to 9.7 ± 12.4 degrees, whereas the mean metacarpophalangeal joint preoperative flexion contracture of 51.4 ± 23.9 degrees was corrected to 7.8 ± 14.1 degrees at postoperative examination ( < 0.05). The median follow-up was 18.7 months, during which the recurrence of contracture was observed in 1 of 28 patients in the group receiving ADM compared with 9 of 104 in the control group ( = 0.37). There were no differences in the incidence of minor wound complications observed.
The adjunct placement of acellular dermal matrix into the wound bed following fasciectomy for DD may be an important surgical strategy to reduce recurrence rates as well as augment coverage of exposed vital structures in cases of severe flexion contracture.
Dupuytren病（DD）手术干预后的复发率仍然很高。在本研究中，我们调查了使用脱细胞真皮基质（ADM）来降低复发率并改善长期临床结果。
我们检查了2007年至2017年期间接受DD开放性筋膜切除术的132例患者。实验组将一片ADM（FlexHD）缝合到手术床中，对照组未用ADM封闭。检查了患者特征、活动范围和并发症。
28例（21.2%）患者接受了脱细胞真皮基质治疗，而104例（78.8%）患者未接受。中位年龄为67.0岁（范围34 - 91岁），两组在年龄、合并症和患侧性方面无差异。ADM组术前指间关节平均屈曲挛缩66.5±29.9度，术后检查时矫正至9.7±12.4度，而术前掌指关节平均屈曲挛缩51.4±23.9度矫正至7.8±14.1度（P<0.05）。中位随访时间为18.7个月，在此期间，接受ADM治疗的组中28例患者中有1例出现挛缩复发，而对照组104例中有9例（P = 0.37）。观察到的轻微伤口并发症发生率无差异。
在DD筋膜切除术后将脱细胞真皮基质附加放置于伤口床可能是一种重要的手术策略，可降低复发率，并在严重屈曲挛缩病例中扩大对暴露重要结构的覆盖。
