Ulnar-based skin flap for Dupuytren's fasciectomy

Full-thickness skin grafting in preventing recurrence of Dupuytren's disease: A systematic review

Dupuytren's disease is a progressive hand disorder characterized by the formation of pathologic nodules and cords in the palm, often leading to progressive flexion contractures. Hand surgery is currently the only efficient treatment to restore hand function, however, reported recurrence rates vary widely. Currently, it remains unclear which type of fasciectomy is associated with the lowest recurrence rate. Therefore, a systematic review was conducted to compare recurrence rates after limited fasciectomy, open palm technique, or dermofasciectomy with a full-thickness skin graft. 79 studies were included, and results suggest that a dermofasciectomy with a full-thickness skin graft is associated with a lower recurrence rate. However, most studies were case series in which a wide range of definitions of recurrence was used. Moreover, all studies had a high risk of bias. Therefore, additional comparative clinical trials are recommended that use an unambiguous definition of recurrence. LEVEL OF EVIDENCE III: .

A meta-analysis to identify novel diagnostic and therapeutic targets for Dupuytren's disease

The aim of this study was to determine novel candidate genes for Dupuytren's disease by performing a meta-analysis. We identified 261 genes (111 up-regulated and 150 down-regulated) that were consistently expressed differentially in Dupuytren's disease across the studies. We performed functional enrichment on total sets of the identified 261 genes and confirmed that most of the genes were closely related to common processes of diseases in general. From the integrated studies of the gene-correlation network and the protein-protein interaction network, we identified three functional modules in the gene co-expression network and four hub gene clusters in the protein-protein interaction network that shared the same genes and represented similar biological functions, implying that the seven groups identified in the systematic analysis of these two networks might be involved in the pathogenesis of Dupuytren's disease. This work demonstrates potential in developing experimental and clinical strategies for understanding and treating Dupuytren's disease.

Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions

PURPOSE

To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results.

METHODS

This study reviewed definitions and rates of contracture correction and recurrence in patients undergoing invasive treatment of Dupuytren contracture. A literature search was carried out in January 2011 using the terms "Dupuytren" AND ("fasciectomy" OR "fasciotomy" OR "dermofasciectomy" OR "aponeurotomy" OR "aponeurectomy") and limited to studies in English.

RESULTS

The search returned 218 studies, of which 21 had definitions, quantitative results for contracture correction and recurrence, and a sample size of at least 20 patients. Definitions for correction of contracture and recurrence varied greatly among articles and were almost always qualitative. Percentages of patients who achieved correction of contracture (ie, responder rate) when evaluated at various times after completion of surgery ranged from 15% to 96% for fasciectomy/aponeurectomy. Responder rates were not reported for fasciotomy/aponeurotomy. Recurrence rates ranged from 12% to 73% for patients treated with fasciectomy/aponeurectomy and from 33% to 100% for fasciotomy/aponeurotomy. Review of these reports underscored the difficulty involved in comparing correction of contracture and recurrence rates for different surgical interventions because of differences in definition and duration of follow-up.

CONCLUSIONS

Clearly defined objective definitions for correction of contracture and for recurrence are needed for more meaningful comparisons of results achieved with different surgical interventions.

CLINICAL RELEVANCE

Recurrence after surgical intervention for Dupuytren contracture is common. This study, which evaluated reported rates of recurrence following surgical treatment of Dupuytren contracture, provides clinicians with practical information regarding expected long-term outcomes of surgical treatment choices.

TYPE OF STUDY/LEVEL OF EVIDENCE

Economic and decision analysis III.