Limited palmar fasciectomy combined with Z-plasty for Dupuytren's disease: A 56 cases review.

Abstract

Introduction: Fasciectomy is the gold standard for treating palmodigital cords in Dupuytren's disease. When flexion contracture predominates at the metacarpophalangeal (MCP) joint, a segmental aponeurectomy in the palm combined with a Z-plasty can be performed. The primary objective of this study was to evaluate the improvement in MCP extension achieved by this limited procedure. The secondary objectives were to assess long-term complications and recurrence rates.

Materials and methods: A retrospective study was conducted on patients who underwent pure palmar segmental fasciectomy with Z-plasty between 2014 and 2023. Palmar fasciectomy was performed on patients with exclusive or predominant MCP Dupuytren's contracture. This local fasciectomy procedure achieved full MCP joint extension. One or more Z-plasties enabled tension-free wound closure. Patients were reviewed, and extension deficit, complications, and recurrence were noted.

Results: 46 patients (56 operated rays) were reviewed, with a mean follow-up period of 26 months (range 10-60 months). The mean preoperative MCP extension deficit was 48.4 °. At the final follow-up, the mean MCP contracture was 6.1 °, representing an improvement rate of 87%. Eleven patients experienced recurrence, five developed complex regional pain syndrome after surgery and one had neurapraxia that resolved spontaneously.

Discussion: Segmental palmar fasciectomy and Z-plasty demonstrated substantial improvement in MCP extension. Complications appear to be fewer than with extended palmo-digital fasciectomy, and the recurrence rate is lower than with collagenase or fasciotomy.

Conclusion: Limited palmar fasciectomy combined with Z-plasty is a simple, safe and effective treatment option for patients with MCP flexion contracture as the predominant or exclusive manifestation of Dupuytren's disease.