[Flap plasty in advanced Dupuytren's disease].

OBJECTIVE

Tension-free skin closure after partial aponeurectomy of fingers in Dupuytren's disease with flexion contracture.

INDICATIONS: Contractures of the proximal interphalangeal (PIP) joint >30° in Dupuytren's disease cannot sufficiently treated by Z-plasty due to the contracted skin conditions.

CONTRAINDICATIONS: Preoperative scar tissue or impaired circulation in the operation region and infections.

SURGICAL TECHNIQUE: The primary plan is to place a sliding flap into the incision line with the PIP joint in a flexed position, under regional anesthesia and temporary arrest of the blood supply of the upper arm by cuffing. Definitive incising round the sliding flap after achieving a PIP extension position and covering of the sliding flap either by another dorsal side flap or by full thickness skin graft.

POSTOPERATIVE MANAGEMENT: Immobilization in a palmar splint, hand physiotherapy and massaging of the scar.

RESULTS

In the time period June 2008 to December 2010 a total of 40 patients were surgically treated. The preoperative angle of contracture in the PIP joint was 30-60° in 25 patients (group 1), 60-90° in 10 patients (group 2) and > 90° in 5 patients (group 3). The angle of contracture 12 months postoperatively was 10-15° in group 1, 20-30° in group 2 and 30-40° in group 3 and after 24 months 15-20° in group 1, 30-45° in group 2 and 40-60° in group 3 . The angle of contracture of the PIP joint was greatest for digit 5. Revision surgery resulted in a poorer outcome. Recovery of sensation lasted up to 2 years after surgery. Complications which occurred were problems in wound healing (4), loss of a flap (1), partial loss of the skin transplant without revision (3), arthrodesis (1) and amputation of digit 5 (1).