Dupuytren Disease-Case: Dupuytren Disease

Case: Dupuytren Disease

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Summary:<br /><br />Case 1 involves a 52-year-old male with proximal and middle joint contracture. The palmar aponeurosis for the ring and little finger is first excised, and sharp dissection is used to release fibrous bands while preserving elastic areolar tissue. No flexor tendon pulleys require resection. During the procedure, care is taken to locate and minimize disturbance to neurovascular bundles. The VY advancement technique allows almost complete extension, but a contracted structure may prevent complete middle joint extension. Steel or dacron wool is used for compression, and a postoperative "bridle" is used for resting in extension. Sutures are left during early mobilization, and splinting is done day and night, removing for ranging every hour. The wound is of concern for postoperative Dupuytren's. A flare reaction may occur postoperatively, usually within 10 days.<br /><br />Case 2 involves the development of a natatory cord 2 years after a fasciectomy for the ring central and spiral little finger cords. Ecchymoses are observed two days after collagenase injection. It is unclear if this is a recurrence. Two weeks after an extension maneuver for the ring and little fingers, it is noted that collagenase treatment has a higher rate of recurrence compared to operative correction.

Keywords

proximal joint contracture

middle joint contracture

palmar aponeurosis

fibrous bands

neurovascular bundles

VY advancement technique

postoperative Dupuytren's

natatory cord

fasciectomy

recurrence