Lappenplastiken bei fortgeschrittenem Morbus Dupuytren

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).