[Malingue's procedure for digital retraction in Dupuytren's contracture--principle, modelling and clinical evaluation].

INTRODUCTION

Malingue's procedure is a modified Z-plasty for the treatment of digital retraction in Dupuytren's contracture. Geometrical modelling was used to determine the theoretical efficacy of the technique, and the clinical value of the method was assessed with a follow-up of 23 patients over at least two years.

MATERIAL AND

METHODS

Unlike Z-plasty, in which the skin flaps transposed are triangular, the Malingue plasty uses trapezoidal flaps. The direct longitudinal approach is used for the cords and the incision lines cut obliquely across the flexion folds. Euclidean geometry allows calculation of the average theoretical gain with a 45 plasty for a finger of width a, the initial surface being given by S1=a²√2, and the surface after plasty by S2=a²(3/4×[√2+1]). A continuous, homogeneous, retrospective series of 27 patients operated by the same surgeon for Dupuytren's contracture with digital flexion contracture was reviewed by a neutral observer. The technique, which combined open-palm fasciectomy with the Malingue plasty, reduced the loss of skin by extending the finger after excising the cords. The plasty was adapted to cover various skin conditions and degrees of finger flexion contracture.

RESULTS

The Malingue procedure was performed as an outpatient procedure in 23 cases. The average theoretical gain of the skin surface was 46%. The results were evaluated immediately after surgery and over a mean follow-up of 31 months. There were ten cases for a first operation, ten with a first recurrence, and seven with a second recurrence. The operated fingers healed within three weeks with no skin distress or dehiscence. The only surgical complication involved a sectioned collateral radial nerve of the ring finger in a recurrence of Dupuytren's contracture; a venous sleeve was used to re-establish the continuity of the nerve. Midterm complications included CRPS in one patient, recurrence of contracture in three patients, and benign lateral hypoesthesia of the first phalanx in two patients. The mean Tubiana score, which fell from 4.0 to 0.18 immediately after surgery, was 0.67 at the last follow-up, with an overall patient satisfaction index of 95%.

CONCLUSION

The Malingue plasty follows a strict but easily applicable protocol. Avoiding the use of skin grafts or flaps, the technique offers satisfactory treatment in most cases of Dupuytren's contracture.