Impressions of Dupuytren's disease.

Of the 450 cases seen in may practice (1946-76), 50 cases were rejected for any kind of treatment for various reasons. In an additional 50 cases, fasciotomy was done at a V.A. facility. This procedure was abandoned in favor of bandectomy. Amputation of useless fingers (usually the acutely contracted small finger) was done in 5 cases at the patient's request to remove this occupational hazard. In the remaining 350 cases of primary fasciectomy, there were 2 cases of accidental severance of the digital nerves in the finger, which were repaired at once. These occurred before I began to use the zigzag incision which provides excellent exposure of the N.V. bundles ensuring their safety. With regard to skin slough, when Z-plasty was used early in this series, there was an occasional slough of the acutely angled tip of the transposed flap. After I began to use the zigzag volar incision, and doubtful skin edges were trimmed away, there was no skin necrosis. Antibiotics were used briefly in a few cases where there was intertrigo with skin maceration at acutely flexed PIP joints. The incidence of seroma, hematoma and infection was zero.