Experience in Treating Patients with Stage IV of Dupuytren Contracture (PNF vs. Fasciectomy)

Fig. 43.1

Results of PNF in patients with stage IV of Dupuytren contracture (group 1). (a) Left hand of a 72-year-old patient with Dupuytren contracture before and 21 days after needle aponeurotomy and rehabilitation treatment, (b) Right hand of a 64-year-old patient before and after needle aponeurotomy and rehabilitation treatment. QR codes for videos demonstrating hand function before and after the operation

43.3.2 Limited Fasciectomy

All patients in group 2 (86 patients) received limited fasciectomy (LF) using microsurgical techniques. In the postoperative period, all patients received rehabilitation therapy. Primary correction of flexion contracture did not exceed 100°. After fixating the finger with the K-wire, we were able to get 140–150° correction. Fixation was used for PIP joints only and for 2–4 weeks. Wounds were closed primarily with the use of different methods of skin plastics using local tissues. Time in hospital was 4–7 days. Function was recovered within 4–20 weeks (Fig. 43.2).

Fig. 43.2

A 51-year-old patient with LF of stage IV of Dupuytren contracture and relapse (group 2). (a) Before operation; (b) palmar aponeurosis removed and skin-fascial pedicle flap from the middle finger is elevated; (c) end of the operation, wounds are closed; donor defect is covered with full-thickness skin graft from the anterior aspect of the elbow region (Wolfe’s graft); (d) recurrence at the same hand 3 months after the operation. The skin graft was used when it was impossible to close a defect using Z-plasty (9 % of cases)

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