Journal of hand surgery global online · 2026
Microscopic Fasciectomy in Dupuytren Disease: Early Clinical Outcomes and Technical Advantages-A District General Hospital Experience.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Shaik Arfaz, Hayat Umar, Al-Saadi Mustafa, Amamilo Chukwuemeka, Hamarsheh Islam, Mohan Arvind
Аннотация
PURPOSE: This study aimed to compare the early postoperative outcomes of microscopic and open fasciectomy for Dupuytren contracture, with a focus on joint correction, residual deformity, survivorship, functional outcomes, and technical benefits.
METHODS: This retrospective review included 40 patients (120 joints) who underwent fasciectomy between January 2023 and January 2025. Microscopy was performed in 21 cases (52.5%). Data were collected on demographics, surgical details, before surgery and postoperative joint angles, residual deformity (defined as >20° at 15-24 weeks), predictors via logistic regression, Kaplan-Meier survivorship, Quick Disabilities of the Arm, Shoulder, and Hand scores, complications, learning curve for microscopy, and surgical staff surveys.
RESULTS: The mean age of the patients was 66 years, and 80% were men. The little finger (51.7%) and proximal interphalangeal joints (52.5%) were the most affected joints. Open fasciectomy targeted more severe preoperative contractures (mean, 54° vs 39°) and yielded greater absolute corrections (53° vs 38°), especially at the metacarpophalangeal joints. Microscopy showed lower residual deformity rates (20% vs 38%) and better correction maintenance with higher survivorship (72.5% overall). Multivariate analysis identified hand therapy sessions as a key predictor of residual deformity and microscopy-trended protective effect. The functional scores averaged 16, with no differences by technique. Complications occurred in 7.5% of the cases, with no notable difference between the groups. Microscopy's learning curve demonstrated increased efficiency over time, alongside intraoperative benefits, such as improved precision and ergonomics.
CONCLUSIONS: Early postoperative outcomes suggest that microscopic fasciectomy may offer modest short-term advantages in maintaining correction, with lower residual deformity, comparable functional outcomes, and a relatively rapid learning curve. Long-term studies are needed to establish whether these early findings support the broader adoption of microscopic techniques in hand surgery with structured training.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
METHODS: This retrospective review included 40 patients (120 joints) who underwent fasciectomy between January 2023 and January 2025. Microscopy was performed in 21 cases (52.5%). Data were collected on demographics, surgical details, before surgery and postoperative joint angles, residual deformity (defined as >20° at 15-24 weeks), predictors via logistic regression, Kaplan-Meier survivorship, Quick Disabilities of the Arm, Shoulder, and Hand scores, complications, learning curve for microscopy, and surgical staff surveys.
RESULTS: The mean age of the patients was 66 years, and 80% were men. The little finger (51.7%) and proximal interphalangeal joints (52.5%) were the most affected joints. Open fasciectomy targeted more severe preoperative contractures (mean, 54° vs 39°) and yielded greater absolute corrections (53° vs 38°), especially at the metacarpophalangeal joints. Microscopy showed lower residual deformity rates (20% vs 38%) and better correction maintenance with higher survivorship (72.5% overall). Multivariate analysis identified hand therapy sessions as a key predictor of residual deformity and microscopy-trended protective effect. The functional scores averaged 16, with no differences by technique. Complications occurred in 7.5% of the cases, with no notable difference between the groups. Microscopy's learning curve demonstrated increased efficiency over time, alongside intraoperative benefits, such as improved precision and ergonomics.
CONCLUSIONS: Early postoperative outcomes suggest that microscopic fasciectomy may offer modest short-term advantages in maintaining correction, with lower residual deformity, comparable functional outcomes, and a relatively rapid learning curve. Long-term studies are needed to establish whether these early findings support the broader adoption of microscopic techniques in hand surgery with structured training.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.