Recontracture Following Surgical Correction of Dupuytren Disease



Dupuytren Disease is a flexion deformity of the proximal interphalangeal joints of the hand. It involves a gradual thickening of the tissue under the skin on the palm of the hand into a cord-like structure. The flexion deformity makes it very difficult to fully straighten the fingers. Though it typically affects the ring and pinky finger, all fingers can be affected. Surgical correction of the flexion contracture is a common procedure that can have varying results, short and long term.

The PIP joint can recontract following surgery either due to post-operative scarring, post-operative joint contracture, or a recurrent Dupuytren Disease. In order to better understand the recurrence rate of contracture, a group of 82 patients exhibiting contracture greater than 30 degrees were recruited to participate in a longitudinal study that followed their progress up periodically over a course of five years after surgery.

The surgical procedure involves excision of the fibrous bands and nodules and a ligament release if necessary, followed by z-plasty. Of the initial 82 patients, a total of 62 showed for follow-up. Of these 62, 49 per cent showed good improvement after surgery that was maintained five years, 32 per cent showed good initial improvement that worsened less than 20 degrees in three months then remained at this level for the five year follow up. Seven per cent of the patients showed immediate severe worsening greater than 20 degrees in the first three months then remained stable after this for the five year follow up. The final group of 12 per cent showed immediate worsening that progressed over the next five years. Four patterns of recontracture following surgical correction were thus identified.

In looking at patient demographics and surgical procedure, a few trends were identified. The progressive recontracture group constituting 12 per cent of the patients had higher disability scores, longer duration of disease and required longer surgical time. These characteristics can be used to help determine success rates of surgical correction for Dupuytren Disease.