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Journal of the Korean Society for Surgery of the Hand 2000;5(1):29-36.
Published online January 1, 2000.
Treatment of Dupuytren's contracture Using the Radical Fasciectomy
Duke Whan Chung, Chae Ik Chung
근막 절제술을 이용한 Dupuytren 구축의 치료
정덕환, 정재익
Abstract
From May 1993 to December 1999, we treated 34 hands of 27 patients with Dupuytren's contracture by surgery in Kyunghee university hospital. We performed retrospective study of these 34 cases of hands and the results were as follows. The purpose of this article is that review the method of treatment especially the methods of surgery, methods of skin incision and analysis the problems of our treatment method. All the patients were male, the average age 62 years old, bilateral involvements were 67%, 18 cases and 26%, 7cases were carried out the operation at the same time. The 85% 29 cases of patients were affected the 4th and the 5th fingers flexion contracture and limitation of extension, 6 cases were affected the 3rd finger and especially one case was involved thumb with nodule and limitation of joint motion, the other one case was invelved sole. We performed subcutaneous fasciotomy in 2 cases, simple excision of nodule in 3 cases, dermofasciectomy and skin graft in 4 cases, and the another 25 cases were carried out the radical fasciectomy and primary closure. In 9 cases of 25 cases were performed primary skin closure at skin incision line and 16 cases were performed Z-plasty. Among them, in one case, partial skin necrosis was progressed and expaned post-operation scar consequently. The functional outcome in radical fasciectomy cases, average 43 degrees of flexion contracture at proximal interphalangeal joint preoperatively and atter 4 weeks of surgery, average 12 degree of it, then, after 12 months of sufgery average 17 degree in 19 cases who were possible to follow up. But in 6 cases who were possible to follow up over 4 yeaers after surgery average flexion contracture angle of proximal interphanangeal joint changed from average 38 degree before surgery, then, average 22 degree after sugery 4 years later. The pain of palmar surface before surgery were in 5 cases only, but after surgery the patient who complained increased pain comparied with preoperatively in 27 cases, 79% but these were not definite distingished discomfort from pain. The complications were 9 cases of digital nerve injury in radial fasciectomy, 2 cases were delayed healing of surgical wound and wound infection. The suspicious recurrence cases were 11 cases, 44% in which sumed scar contracture cases. In conclusion, we recommend the longitudinal skin incision with or without Z-plasty because most surgern may have little experience of treatemnt of Dupuytren's contracture. And also recommend that surgern should be choose the patientso of surgery very carefully because the results of surgery were not relative good.
 


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