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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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.