Dupuytren's contracture: Is a history of percutaneous needle fasciotomy a risk factor for postoperative complications after secondary open fasciectomy? A retrospective study of 62 hands.

Abstract

Introduction: Dupuytren's disease is a benign disorder leading to flexion contracture of the fingers and functional disability. Many treatments have been described. Open fasciectomy is the gold standard; however percutaneous needle fasciotomy (PNF) is a reliable option for uncomplicated primary contracture but it has a high rate of recurrence.

Hypothesis: A history of PNF treatment before open fasciectomy is a risk factor for postoperative complications.

Material and methods: A retrospective single-center study was conducted involving 56 patients (62 hands) who were operated for Dupuytren's contracture by open fasciectomy between November 2016 and November 2020. We compared the outcomes of patients with history of prior PNF on the same finger (group A) to patients without history of PNF (group B). There was no significant difference between the two groups in the severity, comorbidities or preoperative finger mobility. The primary outcome was the complication rate during surgery or during the follow-up period (mean follow-up of 2 years).

Results: The intra- and postoperative complication rate was 26% (n = 9) in group A (history of PNF) versus 9% (n = 4) in group B (no PNF) (p = 0.0482), corresponding to a relative risk for complications of 2.8 (95% CI: 1.2-6.4) in case of previous PNF. Tourniquet time per operated ray was higher in group A than in group B (34.1 min versus 24.9 min, p = 0001).

Discussion: A history of PNF for Dupuytren's disease can lead to a higher rate of major intraoperative or postoperative complications when open fasciectomy is performed compared to open fasciectomy as a first-line therapy.

Level of evidence: III; retrospective comparative study.