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Tomac A, Ion AP, Opriș DR, Arbănași EM, Ciucanu CC, Bandici BC, Coșarcă CM, Covalcic DC, Mureșan AV. Ledderhose's Disease: An Up-to-Date Review of a Rare Non-Malignant Disorder. Clin Pract 2023; 13:1182-1195. [PMID: 37887082 PMCID: PMC10605618 DOI: 10.3390/clinpract13050106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023] Open
Abstract
Plantar fibromatosis (or Ledderhose's disease) is a rare benign condition, difficult to treat, defined by gradual-growing nodules in the central medial part of the plantar fascia, with the possibility of sclerosis and shrinkage of the entire fascia or, rarely, contractures of the toes. From a histopathological point of view, it is linked to Dupuytren's contracture of the hand and Peyronie's disease of the penis, being part of a large group of fibromatoses, based on a proliferation of collagen and fibroblasts. Its etiology is still not fully understood, even though it has been associated with trauma, diabetes mellitus, use of anticonvulsants, frozen shoulder, alcohol consumption, and liver disease. Typically, ultrasound confirms the diagnosis, and magnetic resonance imaging is used for more aggressive and advanced types. Several conservative treatment techniques, such as steroid injections, verapamil, imatinib, radiation therapy, extracorporeal shock wave therapy, tamoxifen, sorafenib, mitomycin C, and collagenase, have been documented. When non-operative care fails, surgical measures may be considered, even though recurrence is expected. We attempted to provide a better understanding of this disease by covering all of the important aspects: its history, clinical and radiologic findings, diagnosis, pathophysiology features, conservative and surgical treatment, recurrence rate, and prognosis.
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Affiliation(s)
- Alexandru Tomac
- Clinic of Plastic Surgery, Saint Spiridon Emergency Clinical Hospital, 700111 Iasi, Romania;
| | - Alexandru Petru Ion
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Diana Roxana Opriș
- Emergency Institute of Cardiovascular Diseases and Transplantation (IUBCVT), 540139 Targu Mures, Romania;
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Claudiu Constantin Ciucanu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (B.C.B.); (C.M.C.); (D.C.C.); (A.V.M.)
| | - Bogdan Corneliu Bandici
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (B.C.B.); (C.M.C.); (D.C.C.); (A.V.M.)
| | - Cătălin Mircea Coșarcă
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (B.C.B.); (C.M.C.); (D.C.C.); (A.V.M.)
| | - Diana Carina Covalcic
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (B.C.B.); (C.M.C.); (D.C.C.); (A.V.M.)
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (B.C.B.); (C.M.C.); (D.C.C.); (A.V.M.)
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
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Zarb RM, Graf AR, Talhelm JE, Stehr RC, Sanger JR, Matloub HS, Daley RA. Dupuytren's Contracture Recurrence and Treatment Following Collagenase Clostridium Histolyticum Injection: A Longitudinal Assessment in a Veteran Population. Mil Med 2023; 188:e2975-e2981. [PMID: 36928340 DOI: 10.1093/milmed/usad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/02/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Dupuytren's contracture is a connective tissue disease characterized by an abnormal proliferation of collagen in the palm and fingers, which leads to a decline in hand function because of progressive joint flexion. In addition to surgical and percutaneous interventions, collagenase clostridium histolyticum (CCH, trade name Xiaflex) is an intralesional enzymatic treatment for adults with palpable cords. The objectives of this study are to evaluate factors predictive of recurrence following treatment with CCH and to review the outcomes of repeat treatments with CCH for recurrent contracture. MATERIALS AND METHODS An institutional review board-approved retrospective chart review was conducted for patients between 2010 and 2017 who received CCH injections for Dupuytren's contracture at a Veterans Affairs hospital. Demographics, comorbidities, affected finger and joint, pre/posttreatment contracture, time to recurrence, and treatment of recurrence were recorded. Successful treatment was defined as contracture ≤5° following CCH, and improvement was defined as ≥20° reduction from baseline contracture. Study cohorts were followed after their secondary treatment, and time to recurrence was recorded and plotted using a Kaplan-Meier curve. A Cox proportional hazards model was used to compare treatment group risk factors for recurrence with a P-value less than .05 defined as statistical significance. RESULTS Of 174 injections performed for the correction of flexion deformities in 109 patients, 70% (121) were successfully treated with CCH, and an additional 20% (35) had improvement. There was a recurrence of contractures in 43 joints (25%). Of these, 16 contractures were treated with repeat CCH, whereas another 16 underwent limited fasciectomy. In total, 75% (12 of 16) of the repeat CCH group and 75% of the fasciectomy group were successfully treated. Pre-injection contracture of ≥25° was found to be predictive of recurrence (P < .05). CONCLUSIONS Initial treatment of contracture with CCH had a 70% success rate with 25% recurrence during the study period. Compared with limited fasciectomy, CCH had decreased efficacy. Based on the findings of this study, we believe that the treatment of primary and/or recurrent Dupuytren's contracture with CCH is a safe and less invasive alternative to fasciectomy in the era of telemedicine. CCH treatment requires no suture removal, which allows the ability to assess motion virtually, and the potential consequences of CCH treatment such as skin tears can be assessed and managed conservatively. In the veteran and active duty population, CCH can facilitate faster recovery and return to service. Strengths of this study include a large series of veteran populations with longitudinal follow-up to determine treatment efficacy for primary Dupuytren's contracture and recurrence. Limitations include a smaller sample size compared to previous trials, a lack of standardized follow-up, and the retrospective nature of our study that prohibits randomization to compare outcomes between CCH treatment and fasciectomy efficacy over time. Directions for future research include stratification of patients by joint and specific digit involvement as well as comparison with percutaneous needle fasciotomy, another minimally invasive technique that could benefit the veteran population at increased risk for developing Dupuytren's disease.
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Affiliation(s)
- Rakel M Zarb
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI 53226, USA
| | - Alexander R Graf
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jacob E Talhelm
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Ryan C Stehr
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI 53226, USA
| | - James R Sanger
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI 53226, USA
- Department of Plastic Surgery, Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA
| | - Hani S Matloub
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI 53226, USA
- Department of Plastic Surgery, Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA
| | - Roger A Daley
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Orthopaedic Surgery, Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI 53295, USA
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Lambi AG, Popoff SN, Benhaim P, Barbe MF. Pharmacotherapies in Dupuytren Disease: Current and Novel Strategies. J Hand Surg Am 2023; 48:810-821. [PMID: 36935324 PMCID: PMC10440226 DOI: 10.1016/j.jhsa.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/27/2022] [Accepted: 02/06/2023] [Indexed: 03/21/2023]
Abstract
Dupuytren disease is a benign, progressive fibroproliferative disorder of the hands. To date, only one pharmacotherapy (clostridial collagenase) has been approved for use in Dupuytren disease. There is a great need for additional nonsurgical methods that can be used to either avoid the risks of invasive treatments or help minimize recurrence rates following treatment. A number of nonsurgical modalities have been discussed in the past and continue to appear in discussions among hand surgeons, despite highly variable and often poor or no long-term clinical data. This article reviews many of the pharmacotherapies discussed in the treatment of Dupuytren disease and novel therapies used in inflammation and fibrosis that offer potential treatment options.
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Affiliation(s)
- Alex G Lambi
- Department of Orthopedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Steven N Popoff
- Department of Orthopaedic Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Prosper Benhaim
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
| | - Mary F Barbe
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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Drinane JJ, Gemoets D, Hoftiezer YAJ, Hoehn J, Eberlin KR. Initial Treatment Choice Affects Cost-Effectiveness and Reintervention Rates for Dupuytren Contracture: A National Census Among Veterans Affairs Patients. Hand (N Y) 2023; 18:885-890. [PMID: 35094589 PMCID: PMC10336801 DOI: 10.1177/15589447211072251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A multitude of treatments for Dupuytren contracture are available, including both invasive and minimally invasive options. This study compares the reintervention rates and costs associated with various treatment options for Dupuytren disease (DD) within the Veterans Affairs (VA) Health Administration. METHODS Using the Corporate Data Warehouse, a national census was performed including all patients treated for DD in years 2014 to 2020 within the VA health care system. Patients treated with collagenase clostridium histolyticum (CCH), percutaneous needle aponeurotomy (PNA), open fasciotomy, palmar fasciectomy, single finger fasciectomy, and multifinger fasciectomy were compared. The total cost of initial treatment was compared between modalities. The 5-year reintervention rates were compared using a Kaplan-Meier analysis. RESULTS During the study period, 8530 patients were treated for DD (3501 fasciectomy, 3351 CCH, 880 PNA, 798 fasciotomy). The overall median treatment cost was found to be the least for PNA (P < .0001). The 5-year reintervention rates were significantly lower for single finger fasciectomy (6.5%), operative fasciotomy (8.2%), and palmar fasciectomy (9%) when compared with PNA (12.3%), multifinger fasciectomy (13.1%), and CCH (14.4%) (P < .001). However, reintervention rates were comparable between patients treated with PNA, multifinger fasciectomy, and CCH (P > .05). CONCLUSIONS Within the VA population, PNA is the most affordable procedure per treatment episode and is associated with reintervention rates that are comparable to those of CCH. Multifinger fasciectomy, CCH, and PNA had comparable reintervention rates. The differences in reintervention rates may partially be explained by patients' willingness to consider additional treatment to correct any remaining or recurrent deformity.
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Affiliation(s)
| | | | | | | | - Kyle R. Eberlin
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
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A 12-Year Review of Clinical Practice Patterns in Dupuytren Contracture Based on Continuous Certification by the American Board of Plastic Surgery. Plast Reconstr Surg 2022; 150:127e-135e. [PMID: 35536765 DOI: 10.1097/prs.0000000000009181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The American Board of Plastic Surgery collects data on 20 common plastic surgery operations as part of the Continuous Certification process. The goal of this study was to describe clinical trends in Dupuytren contracture repair since 2008 as they relate to evidence-based medicine articles published in this timeframe. METHODS Cumulative tracer data for Dupuytren contracture were reviewed for the period from February of 2008 to March of 2020 and compared with evidence-based medicine articles published in Plastic and Reconstructive Surgery . Topics were categorized as (1) pearls, addressed in both the tracer data and evidence-based medicine articles, (2) topics only addressed in tracer data, and (3) topics only addressed in evidence-based medicine articles. RESULTS As of March of 2020, 230 cases of Dupuytren contracture had been entered. The median age at time of surgery was 65 years (range, 38 to 91 years). Practice patterns from 2008 through 2014 were compared with those between 2015 and 2020. The most common surgical technique was limited fasciectomy (62 percent of cases). Differences in practice between these time periods included decrease in the use of radical fasciectomy (34 percent versus 16 percent, p = 0.002), increase in percutaneous cordotomy (0 percent versus 13 percent), and increase in the use of collagenase injections (0 percent versus 9 percent, p = 0.001). Use of Bier blocks increased (1 percent versus 7 percent), and tourniquet use decreased (97 percent versus 80 percent). Significant changes were also noted in postoperative management. CONCLUSION By examining American Board of Plastic Surgery tracer data, the authors have described national trends in presentation and surgical techniques for Dupuytren contracture repair over a 14-year period.
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Warwick D, NM Werker P, Pess G, Hirata H, Hunter-Smith DJ. Dupuytren's disease: using needles more across the world. J Hand Surg Eur Vol 2022; 47:80-88. [PMID: 34496664 PMCID: PMC8721555 DOI: 10.1177/17531934211043307] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 02/03/2023]
Abstract
In this article we take an international perspective on the use of needles, either percutaneous needle fasciotomy (PNF) or Clostridial Collagenase Histiolyticum (CCH), in treating Dupuytren's Disease (DD). Worldwide, PNF is now used more frequently. The CCH has been withdrawn from non-USA markets, which lessens its use. Different patients have different preferences, while different surgeons have different skills and opinions. The surgeon should fully consider the patient's preference and should also, in view of the scarcity of surgical resource and the potential hazard of surgery, reconsider and expand the use of a needle rather than an operation. In the future, a cheaper, yet equally safe and effective alternative to CCH, will provide a useful clinical tool for those cords, which, in the surgeon's personal Venn diagram, are too challenging for PNF, but the patient does not want to have surgery.
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Affiliation(s)
| | - Paul NM Werker
- Department of Plastic Surgery, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - Gary Pess
- Central Jersey Hand Surgery, Eatontown, NJ, USA
| | - Hitoshi Hirata
- Department of Hand Surgery, Graduate School & Faculty of Medicine Nagoya University, Nagoya, Japan
| | - David J Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Clinical School at Monash University, Melbourne, Australia
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Schoenfeld JD, Agaram NP, Lefkowitz RA, Kelly CM, Healey JH, Gounder MM. OUP accepted manuscript. Oncologist 2022; 27:e294-e296. [PMID: 35274715 PMCID: PMC8914480 DOI: 10.1093/oncolo/oyab050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 11/14/2022] Open
Abstract
Palmar and plantar fibromatosis are benign proliferative processes which present as a diffuse thickening or nodules of the hands and/or feet and may lead to flexion contractures, pain, and functional impairment known as Dupuytren and Ledderhose diseases, respectively. Current treatments are noncurative and associated with significant morbidity. Here, we report on the outcomes of 5 patients with advanced disease, no longer surgical candidates, treated with sorafenib. Sorafenib exhibited an expected safety profile. All 5 patients demonstrated objective responses as evaluated by a decrease in tumor size and/or tumor cellularity from baseline and all 5 patients reported subjective pain relief and/or functional improvement. Mechanistically, immunohistochemistry revealed patchy positivity for PDGFRβ, a known target of sorafenib. The outcomes of these 5 patients suggest the safety and efficacy of a relatively well-tolerated oral agent in the treatment of Dupuytren and Ledderhose diseases and suggest the need for future controlled studies.
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Affiliation(s)
- Joshua D Schoenfeld
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Narasimhan P Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Robert A Lefkowitz
- Department of Radiology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Ciara M Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - John H Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Mrinal M Gounder
- Corresponding author: Mrinal M. Gounder, MD, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Almadani YH, Vorstenbosch J, Efanov JI, Xu L. Dupuytren's Disease: An Outcomes-Focused Update. Semin Plast Surg 2021; 35:216-222. [PMID: 34526871 DOI: 10.1055/s-0041-1731631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Dupuytren's disease (DD) remains a common fibroproliferative condition with significant sequelae and impact on patient's lives. The etiology of DD is poorly understood, and genetic predisposition is thought to be a strongly associated factor. Despite remarkable strides in improving our molecular understanding of DD, clinical treatment options have not yet overcome the frequently encountered challenge of recurrence. Recurrence rates continue to shape the prognosis of this fibrotic condition. In this outcomes-focused article, the various treatment modalities are reviewed. This further emphasizes the importance of patient education and providing them with the information to make informed decisions about their treatment.
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Affiliation(s)
- Yasser H Almadani
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joshua Vorstenbosch
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Johnny Ionut Efanov
- Division of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Liqin Xu
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Stewart BD, Nascimento AF. Palmar and plantar fibromatosis: a review. J Pathol Transl Med 2021; 55:265-270. [PMID: 34225446 PMCID: PMC8353138 DOI: 10.4132/jptm.2021.06.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
Palmar fibromatosis (Dupuytren disease/contracture) is the most common type of fibromatosis, defined as a benign proliferation of fibroblasts and myofibroblasts. The disease process is most common in white, middle-aged and older men occurring at the distal palmar crease leading to nodules and contracture, which in many cases recur after surgical treatment. In a similar process, plantar fibromatosis (Ledderhose disease) is a proliferation of fibroblasts and myofibroblasts on the plantar aponeurosis of mostly middle-aged patients that may lead to painful nodules but usually does not lead to contracture. Both processes are histologically similar, composed of a bland cellular proliferation of spindle cells with a bluish appearance and with a variable amount of background collagen, depending on the age of the lesion. The etiology of both lesions is still uncertain, while treatment ranges from observation to surgery, with some pharmacologic agents being investigated with mixed success. In this paper we provide an overview of both processes with regards to clinical and radiologic findings, pathophysiology, diagnosis, treatment, and prognosis.
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Affiliation(s)
- Brian D Stewart
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alessandra F Nascimento
- CWRU School of Medicine, University Hospitals, Bone and Soft Tissue Pathology, Cleveland, OH, USA
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Dupuytren's Fasciectomy: Surgical Pearls in Planning and Dissection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2832. [PMID: 32802632 PMCID: PMC7413789 DOI: 10.1097/gox.0000000000002832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text. Fasciectomy remains the mainstay of surgical treatment for Dupuytren’s disease at many units worldwide, particularly in cases of recurrence after aponeurotomy or enzymatic fasciotomy. In some series, this has been reported as high as 48% in 3 years. The lead author has since abandoned the use of collagenase altogether. In this innovation article, we describe simple maneuvers to aid the planning and dissection of a Dupuytren’s fasciectomy. We describe techniques to enable efficient dissection of the cord and minimize problems when designing skin flaps. We also highlight technical points in revision cases.
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Atluri K, Chinnathambi S, Mendenhall A, Martin JA, Sander EA, Salem AK. Targeting Cell Contractile Forces: A Novel Minimally Invasive Treatment Strategy for Fibrosis. Ann Biomed Eng 2020; 48:1850-1862. [PMID: 32236751 PMCID: PMC7286797 DOI: 10.1007/s10439-020-02497-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
Fibrosis is a complication of tendon injury where excessive scar tissue accumulates in and around the injured tissue, leading to painful and restricted joint motion. Unfortunately, fibrosis tends to recur after surgery, creating a need for alternative approaches to disrupt scar tissue. We posited a strategy founded on mechanobiological principles that collagen under tension generated by fibroblasts is resistant to degradation by collagenases. In this study, we tested the hypothesis that blebbistatin, a drug that inhibits cellular contractile forces, would increase the susceptibility of scar tissue to collagenase degradation. Decellularized tendon scaffolds (DTS) were treated with bacterial collagenase with or without external or cell-mediated internal tension. External tension producing strains of 2-4% significantly reduced collagen degradation compared with non-tensioned controls. Internal tension exerted by human fibroblasts seeded on DTS significantly reduced the area of the scaffolds compared to acellular controls and inhibited collagen degradation compared to free-floating DTS. Treatment of cell-seeded DTS with 50 mM blebbistatin restored susceptibility to collagenase degradation, which was significantly greater than in untreated controls (p < 0.01). These findings suggest that therapies combining collagenases with drugs that reduce cell force generation should be considered in cases of tendon fibrosis that do not respond to physiotherapy.
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Hassan Y, Leveille CF, Gallo L, Santos J, Thoma A, McRae MH, McRae MC. Reporting Outcomes and Outcome Measures in Open Rhinoplasty: A Systematic Review. Aesthet Surg J 2020; 40:135-146. [PMID: 31051500 DOI: 10.1093/asj/sjz138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Comparative studies have shown little statistical difference in outcomes following rhinoplasty, demonstrating near equivalent results across all surgical techniques. Cross-study comparisons of these trials are difficult because variation in outcome reporting prevents statistical pooling and analysis. OBJECTIVES The authors sought to identify all outcomes and outcome measures used to evaluate postoperative results in rhinoplasty. METHODS An extensive computerized database search of MEDLINE and EMBASE was performed; all trials involving n ≥ 20 patients, aged 18 years and older undergoing a primary, open rhinoplasty procedure, were included for review. RESULTS Of the 3235 citations initially screened, 72 studies met the stated inclusion criteria. A total of 53 unique outcomes and 55 postoperative outcome measures were identified. Outcomes were divided into 6 unique domains: objective signs, subjective symptom severity, physical function related to activities of daily living, patient satisfaction, surgeon satisfaction, and quality of life. The identified outcome measures consisted of 5 nasal-specific, author-reported instruments; 5 nasal specific, patient-reported instruments; 5 patient-reported, generic instruments; and 40 author-generated instruments. Of the outcome measures identified, the Rhinoplasty Outcomes Evaluation, Sino-Nasal Outcome Test-22, and FACE-Q were the only instruments to demonstrate adequate validity, reliability, and responsiveness to change in patients who underwent a rhinoplasty procedure. CONCLUSIONS There is heterogeneity in the outcomes and outcome measures employed to assess postsurgical outcomes following rhinoplasty. A standardized core outcome set is urgently needed to make it possible for future investigators to compare results of various techniques in rhinoplasty surgery. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | | | - Lucas Gallo
- McMaster University, Hamilton, Ontario, Canada
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Noto K, Yamamoto M, Iwatsuki K, Kurimoto S, Tatebe M, Hirata H. Acute Pain Intensity After Collagenase Clostridium histolyticum Injection in Patients With Dupuytren Contracture. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:16-20. [PMID: 35415475 PMCID: PMC8991417 DOI: 10.1016/j.jhsg.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/11/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose To investigate multidimensional pain intensity and quality after collagenase Clostridium histolyticum (CCH) injection in patients with Dupuytren contracture using a pain visual analog scale (VAS) and the revised version of the Short-Form McGill Pain Questionnaire (SF-MPQ-2). Methods This prospective observational study was carried out from 2015 to 2017. As a primary end point, patients completed the pain VAS (range, 0 [no pain] to 100) and SF-MPQ-2 before and after CCH injection; 3, 9, and 24 hours after CCH injection; after the extension procedure; and 3 and 7 days after CCH injection. In addition, they reported the dose and duration of supplementary analgesic use during this period. Results A total of 41 patients were enrolled in this study (51 joints). Mean pain VAS score (mean ± SD, 34 ± 21) was maximal 9 hours after CCH injection and decreased within the following 7 days. The total score of the SF-MPQ-2 significantly increased after CCH treatment and decreased in the 7 days after the injection. Among the SF-MPQ-2 subscales, the highest and lowest scores after CCH injection were recorded for continuous pain and affected descriptors, respectively. Nonsteroidal anti-inflammatory drugs were most frequently self-administered during 7 days after the extension procedure compared with any other study period. Conclusions The pain VAS and SF-MPQ-2 revealed acute pain after CCH injection. However, all examined pain aspects dramatically improved within 7 days after injection. Pain after CCH injection is characterized by low scores in the Affective Descriptors subscale of the SF-MPQ-2. Type of study/level of evidence Prognostic Ⅳ.
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Carloni R, Gandolfi S, Elbaz B, Bonmarchand A, Beccari R, Auquit-Auckbur I. Dorsal Dupuytren's disease: a systematic review of published cases and treatment options. J Hand Surg Eur Vol 2019; 44:963-971. [PMID: 31184950 DOI: 10.1177/1753193419852171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Dorsal lesions in Dupuytren's disease are rare and data concerning their epidemiology and management are sparse. We conducted a systematic review to summarize reported cases of dorsal Dupuytren's disease. Pubmed, Cochrane, and Embase databases were searched from 1893 to 2018, and 17 articles were selected (525 patients). The male to female ratio was 3.8:1. The dorsal disease was bilateral in 225 patients (50%). The index was the most commonly affected finger (48 patients). The proximal interphalangeal joint was the most commonly affected (484 cases). The most frequently reported lesions were knuckle pads (503 patients), dorsal nodules between interphalangeal joints (14 patients), boutonnière deformities (12 patients), and swan-neck deformities (2 patients). Nearly half of the included patients were treated surgically. Postoperative functional result depended on the treated lesion. Most of the included studies had a low level of evidence. Higher-quality studies are necessary to confirm our findings.
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Affiliation(s)
| | - Silvia Gandolfi
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Benedicte Elbaz
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Albane Bonmarchand
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Roberto Beccari
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Isabelle Auquit-Auckbur
- Department of Plastic, Reconstructive and Hand Surgery, Charles Nicolle University Hospital, Rouen, France
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Bergovec M, Jelicic J, Oljaca A, Bilic R. Hand function and recurrence after limited fasciectomy for Dupuytren's contracture: Long-term follow-up. J Orthop Surg (Hong Kong) 2019. [PMID: 29529955 DOI: 10.1177/2309499018762195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study was to analyze long-term results after limited fasciectomy for Dupuytren's contracture. METHODS The study included 34 patients (52 rays), with an average follow-up of 9.5 years (range: 7-13 years). Range of motion, functional status, recurrence, and complications were recorded. RESULTS Preoperative metacarpophalangeal joint (MCPJ) contracture (median: 35°, range: 0-90°) improved postoperatively to full extension in all but one patient, with no recurrence at the most recent follow-up. Preoperative proximal interphalangeal joint (PIPJ) contractures (median: 52°, range: 5-100°) were initially corrected, but recurred with time (median: 25°, range 0°-80°). Hand function was assessed using the Disabilities of the Arm, Shoulder and Hand questionnaire. Postoperative hand function improved (median: 0, range: 0-27), compared to preoperative function (median: 20, range: 0-51). Hand function worsened with time (at most recent follow-up: median: 3, range: 0-40), mainly due to PIPJ contracture recurrence, but function remained better than before surgery. CONCLUSION Limited fasciectomy is an effective treatment method for MCPJ, with full correction achievable in both the short and long term. Regarding the PIPJ, treatment outcomes seem to be multifactorial. Further clarification is required to distinguish between local recurrence and remaining contracture of the PIPJ.
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Affiliation(s)
- Marko Bergovec
- 1 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia.,2 Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Josko Jelicic
- 1 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Oljaca
- 2 Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Ranko Bilic
- 1 Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
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Kelenjian S, Mattjie RA, Franz R, Biedermann T, Brockow K. Klinische Merkmale und Management oberflächlicher Fibromatosen. J Dtsch Dermatol Ges 2019; 17:393-398. [DOI: 10.1111/ddg.13808_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Shinorik Kelenjian
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Rebeca Assuncao Mattjie
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Regina Franz
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Knut Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
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Kelenjian S, Mattjie RA, Franz R, Biedermann T, Brockow K. Clinical features and management of superficial fibromatoses. J Dtsch Dermatol Ges 2019; 17:393-397. [PMID: 30865379 DOI: 10.1111/ddg.13808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
Fibromatoses are a group of benign connective tissue tumors characterized by the infiltrative, aggressive proliferation of well-differentiated fibroblasts, leading to frequent local recurrence. Within this heterogeneous disease group, superficial fibromatoses show slower growth and more benign infiltration of surrounding tissues than deep fibromatoses. Superficial fibromatoses relevant to dermatology include palmar, plantar, and penile fibromatosis, knuckle pads, pachydermodactyly and infantile digital fibromatosis. They present clinically with subcutaneous nodules or cords that lead to local infiltration and limited mobility of the affected areas. Treatment options vary from watchful waiting, non-invasive methods such as radiotherapy and intralesional corticosteroid/collagenase injections to radical surgical procedures. Early intervention may disrupt disease progression and may even restore functional ability. These disorders should therefore be recognized and treated early in the course of the disease.
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Affiliation(s)
- Shinorik Kelenjian
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Rebeca Assuncao Mattjie
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Regina Franz
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
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Sanjuán-Cerveró R, Vazquez-Ferreiro P, Gómez-Herrero D, Carrera-Hueso F, Fikri-Banbrahim N. One year follow-up after treatment with CCH for Dupuytren's contracture: A prospective view. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sanjuan-Cerveró R, Carrera-Hueso FJ, Vazquez-Ferreiro P. Adverse effects associated with collagenase clostridium histolyticum in Dupuytren disease: A prospective study. Orthop Traumatol Surg Res 2018; 104:901-905. [PMID: 30253866 DOI: 10.1016/j.otsr.2018.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/22/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Collagenase clostridium histolyticum is now recognized as a viable treatment for Dupuytren disease. The high rate of adverse effects reported in patients continues to spark debate and raise questions about the true frequency of effects and their associated mechanisms of action. HYPOTHESIS To investigate whether outcomes of CCH treatment are related to the number of adverse effects experienced. To evaluate short-term clinical outcomes in a series of patients. MATERIAL AND METHODS Prospective single-center cohort study. The Primary End Point for effectiveness at 30 days was deficit of 0°-5°. Adverse effects were evaluated during CCH injection, removal of the dressing prior to finger extension, and finger extension. To investigate the relationship between adverse effects and treatment effectiveness, we analyzed the association between number of effects and clinical outcome at 30 days. RESULTS A total of 208 injections were evaluated. The mean baseline contracture was 32.11°. Ninety-four patients (45.2%) had a mild contracture. Treatment was effective at 30 days in 194 of the injections (93.3%). The rate of effectiveness per joint was 93.5% for metacarpophalangeal joints (n=129) and 92.9% for proximal-interphalangeal joints (n=65). In total, 734 adverse effects were reported (mean, 3.53). No statistically significant associations were identified between disease severity and secondary effects. Variance analysis showed statistically significant differences in patients with severe contractures (mean, 3.91; 95% CI 3.57-4.25), and in patients with proximal-interphalangeal contractures (mean, 4.17; 95% CI 3.76-4.59). CONCLUSIONS We found no relationship between number of adverse effects and treatment effectiveness at one month following CCH injection. LEVEL OF PROOF IV, cohort prospective study.
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Affiliation(s)
- Rafael Sanjuan-Cerveró
- Orthopedics and Traumatology Surgery, Hospital de Denia, Partida Beniadlà, S/N, Denia, 03700 Alicante, Spain; University of Granada, Spain.
| | | | - Pedro Vazquez-Ferreiro
- University of Granada, Spain; Ophtalmologic Department, Hospital Virxen da Xunqueira, Cee, 15270 A Coruña, Spain
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Walraven M, Hinz B. Therapeutic approaches to control tissue repair and fibrosis: Extracellular matrix as a game changer. Matrix Biol 2018; 71-72:205-224. [DOI: 10.1016/j.matbio.2018.02.020] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 02/08/2023]
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Abstract
Needle aponeurotomy is an effective, minimally invasive treatment for metacarpophalangeal and interphalangeal joint contractures caused by Dupuytren disease. Multiple joints and digits can be safely treated in 1 session. Needle aponeurotomy is more cost-effective and has a significantly lower complication rate compared with open fasciectomy and collagenase injections. Recurrence rates are higher compared with open fasciectomy and collagenase injections. Patient satisfaction rates are high following needle aponeurotomy; the single clinic visit required and the minimal downtime after treatment are advantages unique to this procedure compared with other treatment modalities, including open fasciectomy, dermatofasciectomy, collagenase injections, and lipofilling.
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Affiliation(s)
- Kate E Elzinga
- Section of Plastic Surgery, University of Calgary, 4448 Front Street Southeast, Calgary, Alberta T3M 1M4, Canada
| | - Michael J Morhart
- Division of Plastic Surgery, University of Alberta, 14310 111 Avenue Northwest, Edmonton, Alberta T5M 3Z7, Canada.
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Dress CM, Tassis EK. A case of Dupuytren's disease managed with viable cryopreserved placental membrane adjunct to open palmar fasciectomy. J Surg Case Rep 2018; 2018:rjy055. [PMID: 29644033 PMCID: PMC5888484 DOI: 10.1093/jscr/rjy055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/13/2018] [Indexed: 12/21/2022] Open
Abstract
Dupuytren's disease (DD) is a rare connective tissue disorder resulting in progressive fibrosis and thickening of the palmar fascia, and contracture of the fingers due to excessive collagen deposition. Staged surgical interventions are reserved for severe cases, yet worsening of fibrosis and contracture of fingers post-surgery, has been reported to have a recurrence rate as high as 85%. Here, the authors report on use of viable cryopreserved placental membrane (vCPM) allograft as an adjunct to open fasciectomy. In a patient with debilitating bilateral DD contractures of >20 years duration, this novel approach resulted in a 34.8% range of motion (ROM) improvement and ability to fully extend all digits of the right hand. No adverse events were recorded. At 1 year post-surgery, the patient has no decrease in ROM. Results indicate that vCPM incorporation in open fasciectomy may provide benefit in reducing contracture recurrence in DD patients.
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Affiliation(s)
- Christopher M Dress
- Dress Cosmetic Surgery, 11 Racetrack Road NE, Fort Walton Beach, FL 32547, USA
| | - Elisabet K Tassis
- Osiris Therapeutics, Inc., Columbia, MD 21046, USA
- Correspondence address. Elisabet K. Tassis, Department of Medical Affairs, Osiris Therapeutics, Inc., 7015 Albert Einstein Drive, Columbia, MD 21046, USA. Tel: +1-301-910-4210; Fax: +1-443-545-1701; E-mail:
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One year follow-up after treatment with CCH for Dupuytren's disease: A prospective view. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [PMID: 29519629 DOI: 10.1016/j.recot.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim Clostridium histolyticum collagenase (CCH) is nowadays an alternative treatment for the contracture of Dupuytren. Our objective is to assess its effectiveness at one year in a series of consecutive patients. MATERIAL AND METHOD Prospective study with minimum follow-up of one year. Evaluation of results and adverse effects. RESULTS A total of 75 joints treated in 51 patients were included. The average age was 65.18years (SD: 7.288) and 82.7% were males. The initial mean contraction of the MCP was 34.0 degrees (SD: 27.37), PIP 41.5 degrees (SD: 31.33) and combined impairment (MCF+IFP) of 75.5 degrees (SD: 35.2). Efficacy was achieved in 68 patients (90.7%). Adverse effects were mild and self-limiting. The mean correction for the MCP joint was 28.96 degrees (SD: 26.90) and for PIP it was 28.72 degrees (SD: 24.30). The recurrence rate was 18 (24.0%) joints in 14 patients, being more frequent in severe cases. QuickDASH score showed minimal differences measured before the intervention and once a year. DISCUSSION Our results show a better outcome in mild cases; the outcome was more favourable and with a higher success rate in the MCP joint. QuickDASH score is not a useful tool for the assessment of Dupuytren's contracture. CONCLUSIONS Treatment with CCH for Dupuytren's contracture is an effective treatment in the medium term. It has a poorer outcome in combined joint disorders, 5th finger, PIP and severe cases.
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Zhou C, Hovius SER, Pieters AJ, Slijper HP, Feitz R, Selles RW. Comparative Effectiveness of Needle Aponeurotomy and Collagenase Injection for Dupuytren's Contracture: A Multicenter Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1425. [PMID: 29062633 PMCID: PMC5640330 DOI: 10.1097/gox.0000000000001425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although the efficacy of collagenase clostridium histolyticum (CCH) injections has been demonstrated by randomized clinical trials, the relative effectiveness of CCH remains uncertain. Our aim was to compare the outcomes of CCH with those of percutaneous needle aponeurotomy (PNA) in daily clinical practice. METHODS We analyzed data from patients undergoing PNA or CCH between 2011 and 2014 at 7 practice sites in the Netherlands. We examined the degree of improvement in contracture and adverse effects at 6-12 weeks after surgery or the last injection. Additionally, we invited patients to complete the Michigan Hand Questionnaire before and at 6-12 months follow-up. To minimize the risk of bias, we used propensity score matching. RESULTS Among 130 matched patients (93% Tubiana I or II) undergoing PNA (n = 46) and CCH (n = 84), improvement in contracture was similar: 26 degrees (65% improvement from baseline) for PNA versus 31 degrees (71%) for CCH for affected metacarpophalangeal joints (P = 0.163). This was 16 degrees (50% improvement) versus 17 degrees (42%) for affected proximal interphalangeal joints (P = 0.395), respectively. No serious adverse effects occurred in either of the 2 treatment groups. Of the mild adverse effects, only skin fissures and sensory disturbances were seen in both groups. Through 1-year follow-up, patients reported similar improvements in the overall Michigan Hand Questionnaire score (PNA 5.3 points versus CCH 4.9 points; P = 0.912). CONCLUSIONS In patients with mild contractures (Tubiana I or II), CCH was as effective as PNA in reducing contractures. Both treatments were safe and improved hand function to a similar extent in daily practice.
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Affiliation(s)
- Chao Zhou
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Steven E. R. Hovius
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Adriana J. Pieters
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Harm P. Slijper
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Reinier Feitz
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Ruud W. Selles
- From the Department of Plastic, Reconstructive and Hand surgery, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands; and Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
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Evidence-Based Medicine. Plast Reconstr Surg 2017. [DOI: 10.1097/prs.0000000000003680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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