Download PDF
CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/s-0043-1775882
Original Article

Dupuytren's Disease: A Novel Minimally Invasive Pull-Through Technique

Michele Maruccia 
1   Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
,
Pasquale Tedeschi 
1   Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
,
Francesco Sisto
1   Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
,
Ilaria Converti
1   Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
,
Giuseppe Giudice 
1   Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
,
Rossella Elia 
1   Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background Dupuytren's disease decreases quality of life significantly and often requires surgical treatment, nevertheless there is no actual gold standard. The aim of this study was to introduce the use of minimally invasive pull-through technique.

Methods From 2016 to 2020, 52 patients suffering from Dupuytren's contracture were treated with the minimally invasive pull-through technique. We evaluated the improvement in range of motion, pain, disability, and quality of life in the long term. Total extension deficit, quick disabilities of the arm, shoulder, and hand (QuickDASH), and EuroQol five dimensions—five levels index were systematically scored before each surgical intervention and reevaluated after 24 months.

Results Fourteen patients (26.9%) had already received a previous intervention (percutaneous needle aponeurotomy or collagenase Clostridium histolyticum). The mean preoperative total active extension deficit was 84.0 ± 23.3 degrees (55–130 degrees). Mean follow-up was 36 months. There were no cases of tendon rupture or neurovascular injury. Total active extension deficit at the final follow-up was 3.4 ± 2.3 degrees (0–12 degrees). The mean active range of motion of the MCP and PIP joints were, respectively, 90.5 ± 3.3 degrees (85–96 degrees) and 82.7 ± 2.5 degrees (80–87 degrees). At 24 months after cord excision, a mean 10.7 points improvement in the QuickDASH questionnaire was registered (p < 0.001). Pull-through technique was equally effective both on patients with a primary or a recurrent disease. Eight patients (15.4%) had a recurrence of disease in the metacarpophalangeal joint or proximal interphalangeal joint.

Conclusion The pull-through technique is a simple, accessible, and effective technique for the treatment of Dupuytren's contracture. The use of palmar mini-incisions combined with minimal dissection has a low risk of iatrogenic injury to the neurovascular bundles and tendons, and has a low risk of recurrence rate. This study reflects level of evidence IV.

Keywords

Dupuytren - fasciectomy - pull-through - minimally invasive - recurrence

Authors' Contributions

Conception and design: M.M.


Administrative support: G.G. and R.E.


Provision of study materials or patients: M.M. and F.S.


Collection and assembly of data: P.T., R.E., and I.C.


Data analysis and interpretation: P.T. and R.E.


All authors reviewed and edited the manuscript and approved the final version of the manuscript.


Patient Consent

Written informed consent was obtained from all patients prior to their enrollment.


Ethical Approval

The institutional review board of the hospital involved approved this study (No. 6911).




Publication History

Received: 08 December 2022

Accepted: 15 June 2023

Article published online:
04 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Worrell M. Dupuytren's disease. Orthopedics 2012; 35 (01) 52-60
    CrossrefPubMedGoogle Scholar
  • 2 Desai SS, Hentz VR. The treatment of Dupuytren disease. J Hand Surg Am 2011; 36 (05) 936-942
    CrossrefPubMedGoogle Scholar
  • 3 Jain A, Tarabishy S, Carter J, Gonzalez G, Herrera FA. Cost analysis and national trends in the treatment of Dupuytren contracture comparing collagenase injection, needle fasciotomy, and open fasciectomy procedures. Ann Plast Surg 2021; 86 (6S suppl 5): S625-S627
    CrossrefPubMedGoogle Scholar
  • 4 van Rijssen AL, Ter Linden H, Werker PMN. Five-year results of a randomized clinical trial on treatment in Dupuytren's disease: percutaneous needle fasciotomy versus limited fasciectomy. Plast Reconstr Surg 2012; 129 (02) 469-477
    CrossrefPubMedGoogle Scholar
  • 5 Zhang D, Earp BE, Benavent KA, Blazar P. Collagenase treatment of Dupuytren's disease with minimum 5-year follow-up: recurrence, reintervention, and satisfaction. Plast Reconstr Surg 2020; 146 (05) 1071-1079
    CrossrefPubMedGoogle Scholar
  • 6 Tubiana R. Evaluation of deformities in Dupuytren's disease. Ann Chir Main 1986; 5 (01) 5-11
    CrossrefPubMedGoogle Scholar
  • 7 Hueston JT. Table top test. Med J Aust 1976; 2 (05) 189-190
    CrossrefPubMedGoogle Scholar
  • 8 Werker PMN, Pess GM, van Rijssen AL, Denkler K. Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions. J Hand Surg Am 2012; 37 (10) 2095-2105.e7
    CrossrefPubMedGoogle Scholar
  • 9 Budd HR, Larson D, Chojnowski A, Shepstone L. The QuickDASH score: a patient-reported outcome measure for Dupuytren's surgery. J Hand Ther 2011; 24 (01) 15-20 , quiz 21
    CrossrefPubMedGoogle Scholar
  • 10 Beaton DE, Wright JG, Katz JN. Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005; 87 (05) 1038-1046
    Google Scholar
  • 11 Dolan P. Modeling valuations for EuroQol health states. Med Care 1997; 35 (11) 1095-1108
    CrossrefPubMedGoogle Scholar
  • 12 Felici N, Marcoccio I, Giunta R. et al. Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence. Handchir Mikrochir Plast Chir 2014; 46 (06) 350-354
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Kan HJ, Verrijp FW, Hovius SER, van Nieuwenhoven CA, Selles RW. Dupuytren Delphi Group. Recurrence of Dupuytren's contracture: a consensus-based definition. PLoS ONE 2017; 12 (05) e0164849
    CrossrefPubMedGoogle Scholar
  • 14 Hueston JT. Current state of treatment of Dupuytren's disease. Ann Chir Main 1984; 3 (01) 81-92
    CrossrefPubMedGoogle Scholar
  • 15 Smith AC. Diagnosis and indications for surgical treatment. Hand Clin 1991; 7 (04) 635-642 , discussion 643
    CrossrefPubMedGoogle Scholar
  • 16 Paynter JA, Tobin V, Rozen WM, Hunter-Smith DJ. Dupuytren disease management trends: a survey of hand surgeons. J Hand Surg Asian Pac Vol 2020; 25 (04) 453-461
    CrossrefPubMedGoogle Scholar
  • 17 Hozack BA, Rayan GM. Surgical treatment for recurrent Dupuytren disease. Hand (N Y) 2023; 18 (04) 641-647
    CrossrefPubMedGoogle Scholar
  • 18 Kim SW, Hong JP, Lee WJ, Chung YK, Tark KC. Single-stage Achilles tendon reconstruction using a composite sensate free flap of dorsalis pedis and tendon strips of the extensor digitorum longus in a complex wound. Ann Plast Surg 2003; 50 (06) 653-657
    CrossrefPubMedGoogle Scholar
  • 19 Krefter C, Marks M, Hensler S, Herren DB, Calcagni M. Complications after treating Dupuytren's disease. A systematic literature review. Hand Surg Rehabil 2017; 36 (05) 322-329
    CrossrefPubMedGoogle Scholar
  • 20 van Rijssen AL, Gerbrandy FSJ, Ter Linden H, Klip H, Werker PMN. 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 Am 2006; 31 (05) 717-725
    CrossrefPubMedGoogle Scholar
  • 21 van Rijssen AL, Werker PMN. Treatment of Dupuytren's contracture; an overview of options [in Dutch]. Ned Tijdschr Geneeskd 2009; 153: A129
    PubMedGoogle Scholar
  • 22 Foucher G, Medina J, Navarro R. Percutaneous needle aponeurotomy: complications and results. J Hand Surg Br 2003; 28 (05) 427-431
    CrossrefPubMedGoogle Scholar
  • 23 Badalamente MA, Hurst LC. Enzyme injection as nonsurgical treatment of Dupuytren's disease. J Hand Surg Am 2000; 25 (04) 629-636
    CrossrefPubMedGoogle Scholar
  • 24 Peimer CA, Blazar P, Coleman S, Kaplan FTD, Smith T, Lindau T. Dupuytren Contracture Recurrence Following Treatment With Collagenase Clostridium histolyticum (CORDLESS [Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study]): 5-year data. J Hand Surg Am 2015; 40 (08) 1597-1605
    CrossrefPubMedGoogle Scholar
  • 25 Cocci A, Russo GI, Salamanca JIM, Ralph D, Palmieri A, Mondaini N. The End of an era: withdrawal of Xiapex (Clostridium histolyticum Collagenase) from the European Market. Eur Urol 2020; 77 (05) 660-661
    CrossrefPubMedGoogle Scholar
  • 26 Hurst LC, Badalamente MA, Hentz VR. et al; CORD I Study Group. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med 2009; 361 (10) 968-979
    CrossrefPubMedGoogle Scholar
  • 27 Kasture S, Sakamuri R. Long-term outcomes of collagenase Clostridium histolyticum injection for palmar Dupuytren's deformity correction. Cureus 2021; 13 (11) e19952
    PubMedGoogle Scholar
  • 28 Zhou C, Hovius SER, Slijper HP. et al. Collagenase Clostridium histolyticum versus limited fasciectomy for Dupuytren's contracture: outcomes from a Multicenter Propensity Score Matched Study. Plast Reconstr Surg 2015; 136 (01) 87-97
    CrossrefPubMedGoogle Scholar
  • 29 Gelman S, Schlenker R, Bachoura A. et al. Minimally invasive partial fasciectomy for Dupuytren's contractures. Hand (N Y) 2012; 7 (04) 364-369
    CrossrefPubMedGoogle Scholar
  • 30 Basso MA, Bernasconi A, Balato G, Cozzolino A, Famiglietti G, Smeraglia F. Clinical results of collagenase treatment for Dupuytren's disease: a case series study with 2-years follow-up. Acta Ortop Bras 2023; 31 (spe1): e259218
    CrossrefPubMedGoogle Scholar
  • 31 Van Beeck A, Van den Broek M, Michielsen M, Didden K, Vuylsteke K, Verstreken F. Efficacy and safety of collagenase treatment for Dupuytren's disease: 2-year follow-up results. Hand Surg Rehabil 2017; 36 (05) 346-349
    CrossrefPubMedGoogle Scholar
  • 32 Shin EK, Jones NF. Minimally invasive technique for release of Dupuytren's contracture: segmental fasciectomy through multiple transverse incisions. Hand (N Y) 2011; 6 (03) 256-259
    CrossrefPubMedGoogle Scholar
  • 33 Moermans JP. Long-term results after segmental aponeurectomy for Dupuytren's disease. J Hand Surg Br 1996; 21 (06) 797-800
    CrossrefPubMedGoogle Scholar
  • 34 Moermans JP. Segmental aponeurectomy in Dupuytren's disease. J Hand Surg Br 1991; 16 (03) 243-254
    CrossrefPubMedGoogle Scholar