Complications and recurrence in severe Dupuytren's retractions

IF 0.9 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation Pub Date : 2024-12-01 DOI:10.1016/j.hansur.2024.101827

Rodrigo Guerra Sabongi

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引用次数: 0

Abstract

Dupuytren's disease (DD) is a chronic, progressive condition marked by abnormal thickening of the palmar fascia, which leads to hand contractures and functional limitations. Severe cases, particularly in younger patients or those with a strong diathesis, often have higher recurrence rates following treatment. This review explores the challenges in managing severe Dupuytren's retractions, focusing on the complications and recurrence rates associated with different surgical and non-surgical treatment options.

This review analyzes existing literature on the outcomes of various treatment strategies for severe Dupuytren's disease from the past 20 years, with an emphasis on recurrence and complications. The review includes studies from databases like PubMed, Scopus, and the Cochrane Library, focusing on both surgical and non-surgical treatments. Studies were selected based on treatment type, disease severity, patient demographics, and length of follow-up.

Recurrence rates in severe DD vary widely, ranging from 20% to 85% depending on the treatment method. Common complications include nerve damage, delayed wound healing, infection, stiffness, and complex regional pain syndrome (CRPS). Non-surgical treatments, such as collagenase injections, often have fewer immediate complications but show higher recurrence rates over time, especially in younger patients, those with bilateral disease, and those with PIP joint involvement.

Evidence indicates that while surgical treatments can reduce recurrence rates in severe cases, they are also associated with significant complications. Dermofasciectomy has a lower recurrence rate compared to fasciectomy but carries a higher risk of short-term complications. Factors like age, disease severity, and diathesis significantly influence patient outcomes. Non-surgical options, such as collagenase injections, provide temporary relief but are less effective in preventing long-term recurrence in severe DD. The combination of high recurrence risk and treatment-related complications makes managing severe cases particularly challenging, emphasizing the need for personalized treatment approaches.

Severe Dupuytren's disease poses a complex clinical challenge with high rates of recurrence and complications, necessitating individualized treatment strategies. Continued research is essential to improve therapeutic approaches and better address these challenges.

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重度双膝肌回缩的并发症及复发

Dupuytren's disease （DD）是一种慢性进行性疾病，其特征是掌筋膜异常增厚，导致手部挛缩和功能限制。严重的病例，特别是年轻患者或素质较强的患者，治疗后复发率往往较高。这篇综述探讨了治疗严重Dupuytren's后缩的挑战，重点是不同手术和非手术治疗方案的并发症和复发率。本综述分析了近20年来重症Dupuytren病的各种治疗策略的结果，重点分析了复发和并发症。该综述包括来自PubMed、Scopus和Cochrane图书馆等数据库的研究，重点关注手术和非手术治疗。研究是根据治疗类型、疾病严重程度、患者人口统计和随访时间选择的。严重DD的复发率差别很大，根据治疗方法的不同，复发率从20%到85%不等。常见的并发症包括神经损伤、伤口愈合延迟、感染、僵硬和复杂区域疼痛综合征（CRPS）。非手术治疗，如胶原酶注射，通常有较少的直接并发症，但随着时间的推移，复发率较高，特别是在年轻患者、双侧疾病患者和PIP关节累及患者中。有证据表明，虽然手术治疗可以降低严重病例的复发率，但它们也与严重的并发症有关。与筋膜切除术相比，皮筋膜切除术的复发率较低，但短期并发症的风险较高。年龄、疾病严重程度和素质等因素显著影响患者的预后。非手术选择，如胶原酶注射，提供暂时的缓解，但在预防严重DD的长期复发方面效果较差。高复发风险和治疗相关并发症的结合使得管理严重病例特别具有挑战性，强调了个性化治疗方法的必要性。严重的Dupuytren病是一个复杂的临床挑战，具有高复发率和并发症，需要个性化的治疗策略。持续的研究对于改进治疗方法和更好地应对这些挑战至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hand Surgery & Rehabilitation Medicine-Surgery

CiteScore

1.70

自引率

27.30%

发文量

审稿时长

49 days

期刊介绍： As the official publication of the French, Belgian and Swiss Societies for Surgery of the Hand, as well as of the French Society of Rehabilitation of the Hand & Upper Limb, ''Hand Surgery and Rehabilitation'' - formerly named "Chirurgie de la Main" - publishes original articles, literature reviews, technical notes, and clinical cases. It is indexed in the main international databases (including Medline). Initially a platform for French-speaking hand surgeons, the journal will now publish its articles in English to disseminate its author''s scientific findings more widely. The journal also includes a biannual supplement in French, the monograph of the French Society for Surgery of the Hand, where comprehensive reviews in the fields of hand, peripheral nerve and upper limb surgery are presented. Organe officiel de la Société française de chirurgie de la main, de la Société française de Rééducation de la main (SFRM-GEMMSOR), de la Société suisse de chirurgie de la main et du Belgian Hand Group, indexée dans les grandes bases de données internationales (Medline, Embase, Pascal, Scopus), Hand Surgery and Rehabilitation - anciennement titrée Chirurgie de la main - publie des articles originaux, des revues de la littérature, des notes techniques, des cas clinique. Initialement plateforme d''expression francophone de la spécialité, la revue s''oriente désormais vers l''anglais pour devenir une référence scientifique et de formation de la spécialité en France et en Europe. Avec 6 publications en anglais par an, la revue comprend également un supplément biannuel, la monographie du GEM, où sont présentées en français, des mises au point complètes dans les domaines de la chirurgie de la main, des nerfs périphériques et du membre supérieur.