A Study of Outcome of Limited Fasciectomy in Patients with Dupuytrens Contracture

Abstract

Background: Dupuytrens contracture is a fibro proliferative disorder of hand resulting in slowly progressive thickening and shortening of palmar fascia leading to finger flexion contractures. The disease usually affects the fourth and fifth fingers and common in elderly males. The disease progresses in 3 stages with varying clinical severity. The aim of treatment is to remove the contracture of the fascia, correct the flexion deformity and regain the finger function. The treatment options include nonsurgical and surgical methods. The surgical methods include fasciotomy, fasciectomy, dermofasciectomy. Fasciectomy is the commonly done surgical procedure and it can be either limited or radical fasciectomy.

Aims and Objectives: To study the outcome of limited fasciectomy in patients with Dupuytrens contracture

Observations: It is a prospective study conducted in this institute in 25 patients with Dupuytrens contracture operated by limited fasciectomy, between January 2013 and December 2015. All 25 patients of Dupuytrens contracture who presented to us were admitted, evaluated for their severity and operated by limited fasciectomy. Patients were followed up for a period of 6 months to 2 years and evaluated for finger extension and range of movements. 20 of the 25 patients who were operated by limited fasciectomy had complete release of the contractures with normal wound healing and complete extension of fingers. No recurrence of disease was seen in all of these patients on regular follow up and active physiotherapy. Normal range of finger movements were present. 5 of the patients had minor surgical complications in the form of flap necrosis, partial skin graft loss and wound dehiscence, which resolved with conservative dressings and splinting and 2 of these patients developed flexion contractures at 6 months of followup.

Conclusion: Limited fasciectomy is effective in all severity of Dupuytrens contractures with complete relief of symptoms and complete extension of fingers. No recurrence of contractures were seen in 92% of these patients. Limited fasciectomy being less morbid compared to radical fasciectomy or dermofasciectomy is a preferred surgical option in patients with Grade 1 and grade 2 Dupuytrens contractures.