Radiotherapy in Dupuytren's disease: a systematic review of the evidence

Radiotherapy has been advocated as an alternative treatment in early Dupuytren's disease. We have systematically reviewed the evidence on the use of radiotherapy in Dupuytren's disease. Only six articles met a minimum set standard, five of which were retrospective cohort studies and one a randomized controlled study. A total of 770 Dupuytren's hands, nearly all with Tubiana stage 0-1 disease, were irradiated with an average 30 Gy. Disease regression ranged from 0%-56%, stability from 14%-98% and progression from 2%-86%. Salvage surgery was successful in all cases of disease progression post-radiotherapy. There were no reports of adverse wound healing problems associated with such surgery or radiotherapy-associated malignancy. On balance, radiotherapy should be considered an unproven treatment for early Dupuytren's disease due to a scarce evidence base and unknown long-term adverse effects. Well-designed randomized controlled studies are required to confirm the benefits of radiotherapy treatment.

LEVEL OF EVIDENCE

II.

Experience of Integra(®) in cancer reconstructive surgery

OBJECTIVES

Integra® has already established its role in acute burn injuries and scar management. It can also be used to cover non-vascularised wounds such as exposed bone resulting from trauma or tumour resection. The aim of this series was to review all cases that underwent Integra® reconstruction following cancer excision. In particular we were interested in the use of Integra for day-case and local anaesthetic procedures in cases where excision was required down to bone or tendon.

METHODS

All patients who had Integra reconstruction over a three-year period were prospectively followed. A total of 14 cases were identified for inclusion into the series. In each case patient factors such peripheral vascular disease, age and patient choice meant that traditional methods of reconstruction were not possible. As a result a staged Integra® reconstruction was performed.

RESULTS

The 14 cases comprised 11 (78%) males and 3 (22%) females with the majority being diagnosed with Squamous cell carcinomas, 3 (40%) or Malignant Melanomas, 3 (20%). The most common operative sites were digital (5) and scalp (6) in 72% of the cases. The average graft take was 87%. There were 4 early, 4 delayed and 3 late complications in a total of 8 patients mostly resulting in a delay in healing. In 6/14 patients (43%) there were no complications.

CONCLUSIONS

Tumour excision and wide local excision may leave patients with defects requiring complex reconstructive surgery. The options available are often compounded by various patient factors. In complex cases we have found the use of Integra® to be a safe and viable alternative to traditional methods of wound closure.

Experience of Integra(®) in cancer reconstructive surgery

OBJECTIVES

Integra® has already established its role in acute burn injuries and scar management. It can also be used to cover non-vascularised wounds such as exposed bone resulting from trauma or tumour resection. The aim of this series was to review all cases that underwent Integra® reconstruction following cancer excision. In particular we were interested in the use of Integra for day-case and local anaesthetic procedures in cases where excision was required down to bone or tendon.

METHODS

All patients who had Integra reconstruction over a three-year period were prospectively followed. A total of 14 cases were identified for inclusion into the series. In each case patient factors such peripheral vascular disease, age and patient choice meant that traditional methods of reconstruction were not possible. As a result a staged Integra® reconstruction was performed.

RESULTS

The 14 cases comprised 11 (78%) males and 3 (22%) females with the majority being diagnosed with Squamous cell carcinomas, 3 (40%) or Malignant Melanomas, 3 (20%). The most common operative sites were digital (5) and scalp (6) in 72% of the cases. The average graft take was 87%. There were 4 early, 4 delayed and 3 late complications in a total of 8 patients mostly resulting in a delay in healing. In 6/14 patients (43%) there were no complications.

CONCLUSIONS

Tumour excision and wide local excision may leave patients with defects requiring complex reconstructive surgery. The options available are often compounded by various patient factors. In complex cases we have found the use of Integra® to be a safe and viable alternative to traditional methods of wound closure.