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Reoperative Dupuytren Contracture

  • James H. CalandruccioEmail author
  • Scott E. Hecox
Chapter

Abstract

Dupuytren disease (DD) is a challenging clinical problem even with primary surgical cases. However, in the face of recurrence, the surgeon is frequently left with a more challenging and complex problem. Soft tissues may be more adherent because of scar formation, and the anatomy may be distorted making identification of structures such as the nerves and vessels more problematic. Furthermore, the flexor pulley system can be damaged while trying to remove some of these recurrent cords and adherent scar risking potential bow-stringing of the flexor tendons. This chapter outlines some of the options for reoperation on recurrent DD. This type of surgery takes not only skill, but extreme patience on the part of the surgeon as the dissection can be quite tedious. Fortunately, patients are usually grateful for the improvement in function that is obtained.

Keywords

Dupuytren disease Recurrence Reoperation Cord 

References

  1. 1.
    Calandruccio JH. Dupuytren contracture. Chap. 72 in Part XVIII: “The hand”. In: Canale ST, Beaty JH, editors. Campbell’s operative orthopaedics. 11th ed. Philadelphia: Mosby Elsevier; 2008. p. 4273–84.CrossRefGoogle Scholar
  2. 2.
    Russ R. The surgical aspects of Dupuytren’s contraction. Am J Med Sci. 1908;135:856.CrossRefGoogle Scholar
  3. 3.
    Rayan GM. Dupuytren disease: anatomy, pathology, presentation, and treatment. J Bone Joint Surg Am. 2007;89:189–98.PubMedCrossRefGoogle Scholar
  4. 4.
    Rodrigo JJ, et al. Treatment of Dupuytren’s contracture. Long-term results after fasciotomy and fascial excision. J Bone Joint Surg. 1976;58(3):380–7.PubMedGoogle Scholar
  5. 5.
    Rousch TF, Stern PJ. Results following surgery for recurrent Dupuytren’s disease. J Hand Surg [Am]. 2000;25:291–6.CrossRefGoogle Scholar
  6. 6.
    Ketchum LD, Hixson FD. Dermofasciectomy and full-thickness grafts in the treatment of Dupuytren’s contracture. J Hand Surg [Am]. 1987;12:659–64.Google Scholar
  7. 7.
    van Rijssen AL, et al. A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren’s disease: a 6-week follow-up study. J Hand Surg. 2006;31A(5):717–25.Google Scholar
  8. 8.
    Van Russen AL, Werker PMN. Percutaneous needle fasciotomy in Dupuytren’s disease. J Hand Surg. 2006;31(5):498–501.Google Scholar
  9. 9.
    Cools H, Verstreken J. The open palm technique in the treatment of Dupuytren’s disease. Acta Orthop Belg. 1994;60(4):413–20.PubMedGoogle Scholar
  10. 10.
    Gonzalez RI. Dupuytren’s contracture of the fingers: a simplified approach to surgical treatment. California Medicine. West J Med. 1971;115(2):25–31.Google Scholar
  11. 11.
    Hurst LC, et al. Injectable collagenase Clostridium histolyticum for Dupuytren’s contracture. New Engl J Med. 2009;361(10):968–79.PubMedCrossRefGoogle Scholar
  12. 12.
    McFarlane RM, McGrouther DA, Flint MH, editors. Dupuytren’s disease: biology and treatment. Edinburgh: Churchill Livingstone; 1990.Google Scholar
  13. 13.
    Badalamente M, et al. Collagen as a clinical target: nonoperative treatment of Dupuytren’s disease. J Hand Surg. 2002;27A(5):788–98.Google Scholar
  14. 14.
    Badalamente M, Hurst L. Efficacy and safety of injectable mixed collagenase subtypes in the treatment of Dupuytren’s contracture. J Hand Surg. 2007;32A(6):767–74.Google Scholar
  15. 15.
    Boyer MI, Gelberman RH. Complications of the operative treatment of Dupuytren’s disease. Hand Clin. 1999;15(1):161–6, viii.Google Scholar
  16. 16.
    Chung KC, Segalman KA. Microvascular solution for vascular complication in surgery for Dupuytren’s contracture: a case report. J Hand Surg Am. 1996;21(4):711–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryUniversity of Tennessee—Campbell ClinicGermantownUSA

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