The Use of Acellular Dermal Matrix in Dupuytren Disease

Fig. 41.1

Patient with symptomatic Dupuytren Disease, preoperative

Fig. 41.2

Intraoperative placement of a sheet of acellular dermal matrix in wound bed following standard fasciectomy in the same patient from Fig. 41.1; postoperatively, the finger was completely straightened

Patient demographic information was collected for all patients. Additionally, severity of disease, recurrence of disease, wound complications, and other medical comorbidities were recorded. Bivariate analyses were performed using χ ² analysis using IBM SPSS Statistics version 19.0.0 (IBM, Armonk, NY).

41.3 Results

Our study included 23 patients in the group treated with acellular dermal matrix at the time of open fasciectomy as well as 20 patients in the control group treated only with standard fasciectomy. The median age of the entire patient cohort was 66.5 years (range 54 to 91). There were no statistically significant differences between the two patient groups in terms of age, length of follow-up, severity of disease on initial presentation, presence of diabetes or prostate cancer, use of beta-blockers or alcohol, and presence of seizure disorder (Table 41.1). The locations of disease were also comparable between these two groups (Table 41.2).

Table 41.1

Characteristics of control and acellular dermal matrix patient cohorts

Characteristic	Control group (n = 20)	Dermal matrix group (n = 23)
Median age	66	69
Diabetes	5	4
Prostate cancer	8	8
Beta-blockers	3	7
Significant alcohol history	7	9
History of seizure disorder	1	2

Table 41.2

The distribution of affected areas of the hand is similar between the two groups

Affected part of the hand	Control group	Dermal matrix group
Small finger	11	11
Ring finger	14	15
Middle finger	5	7
Index finger	1	1
Thumb	0	2
Palm	8	9

We observed a median follow-up of 1.8 years. During the follow-up period, recurrence of disease was observed in 5 of 20 patients (25.0 %) in the control group. In contrast, recurrence was only noted in 1 of 23 patients (4.3 %) in the group with acellular dermal matrix placed. The difference in recurrence rates between these two groups was statistically significant (P = 0.045) (Fig. 41.3).

Fig. 41.3

The recurrence of disease was 25 % in the control group compared to 4.3 % in the group with acellular dermal matrix placed

Three patients in each group had minor wound complications following surgery. These wound complications all healed with local wound care. We also noted that, interestingly, two patients in the group with acellular dermal matrix placement were noted to have disease extension beyond the border of the acellular dermal matrix, but had no clinical evident recurrence under the area covered by the acellular dermal matrix.

41.4 Discussion

In this study, we propose a novel modification to the standard open fasciectomy for the treatment of Dupuytren Disease. We demonstrate that recurrence rates are lower in patients who have a sheet of acellular dermal matrix placed in the wound bed following fasciectomy compared to patients treated with standard fasciectomy for Dupuytren Disease. We observed comparable complication rates between these two groups of patients. Our results have implications for the treatment of Dupuytren Disease.

Currently, no ideal treatment modality exists for Dupuytren Disease. Surgical treatment options such as the standard fasciotomies and fasciectomies are associated with high recurrence rates (Crean et al. 2011). Percutaneous fasciotomies are also associated with high rates of disease recurrence (van Rijssen et al. 2012). Treatment with collagenase injections is also associated with high recurrence rates, with a reported 75 % recurrence rate at eight years following initial injection (Watt et al. 2010). Additionally, up to 100 % of patients receiving collagenase injection for therapy experience at least one treatment-related adverse event, compared to only 21 % of patients undergoing placebo injection (Hurst et al. 2009; Gilpin et al. 2010).

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