|The treatment of Dupuytren's contracture bounded by factual constraints of its biology:
In addition, there are personal observations that:
- There is not a pharmacological cure.
- Open surgery has significant risk of permanent complications, even for experienced surgeons.
- Recurrence is common after surgery.
- More radical surgery results in longer remission, but proportionally higher rates of complications.
surgery for recurrent Dupuytren's contracture has twice the
complication rate of first time surgery, and recurrences may not be
able to be treated with repeat surgery.
contractures recurring after fasciectomy usually
involve issues independent of Dupuytren's such as flexor
sheath shortening and PIP capsuloligamentous contractures.
PIP contractures occuring in the absence of clinical Dupuytren's
disease generally do not progress after the first postoperative year.
- isolated small
finger PIP contractures in women are so prone to rapid recurrence that
dermofasciectomy should be considered as the first open procedure.
fusion is a safer alternative to repeat palmar procedures for recurrent
PIP contractures, but may require significant (1-2 cm) shortening.
case is presented to demonstrate some of the difficulties encountered
in the treatment of recurrent Dupuytren's contracture.