Stoneham Adam, Fetouh Sherif, Kazzam Muattaz, Warwick David
Department of Trauma and Orthopaedics, University of Southampton Teaching Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom.
Department of Trauma and Orthopaedics, North Shore Hospital, Shakespeare Road, Takapuna, Auckland 0620 New Zealand.
JPRAS Open. 2024 Jul 20;41:372-375. doi: 10.1016/j.jpra.2024.07.003. eCollection 2024 Sep.
Dupuytren's disease continues to present many challenges for the surgeon. A variety of surgical approaches and their variations have been described in the literature, further complicated by the degree of skin shortage and/or the need for local flap procedures or a full thickness skin graft. In the face of all these decisions - none of which is supported by Level 1 evidence - it can be very difficult to plan the best incision(s). We describe a safe and reproducible technique to plan fasciectomy incisions in primary or recurrent Dupuytren's disease. Our short communication and accompanying artwork demonstrates the anatomical landmarks and a simple decision-making algorithm based on just 3 key stages: (1) Proximal incision planning and execution of the palmar release(s); (2) Extension distally into the digit(s) based on the tissue quality, with either with zigzag (Brunner's) or a midline longitudinal (McIndoe) incision(s); (3) Flap assisted closure or coverage with a full thickness skin graft where required.
Dupuytren挛缩症对外科医生来说仍然存在诸多挑战。文献中描述了多种手术方法及其变体，而皮肤短缺的程度和/或局部皮瓣手术或全厚皮片移植的需求更是使其变得复杂。面对所有这些决策——且无一有一级证据支持——规划最佳切口可能非常困难。我们描述了一种安全且可重复的技术，用于规划原发性或复发性Dupuytren挛缩症的筋膜切除术切口。我们的简短通讯及附带的插图展示了解剖标志以及基于三个关键步骤的简单决策算法：(1) 近端切口规划及掌部松解术的实施；(2) 根据组织质量向远端延伸至手指，采用锯齿状（布伦纳氏）或中线纵向（麦金杜氏）切口；(3) 根据需要采用皮瓣辅助缝合或全厚皮片覆盖。
