Recurrent Dupuytren contracture treated with fasciectomy and skin grafting

Abstract

Recurrent Dupuytren contracture can be aggressive and prone to further recurrence even with surgical treatment. Recurrence risk is increased further by the presence of Dupuytren diathesis. Surgical fasciectomy allows for subtotal or total excision of the pathological Dupuytren cords and resultant contracture correction in recurrent contracture. Extra care must be taken in revision fasciectomy cases to carefully identify and protect the neurovascular bundles as their anatomy will be distorted by both Dupuytren tissue and scarring from prior surgery. Tension on the neurovascular bundles of the digit may compromise the neurovascular status of the digit in cases of severe contracture and full correction may not be possible. When closure of surgical wounds with Z-plasties alone is not possible, full-thickness skin grafting from the hypothenar eminence provides glabrous, non-hair bearing, durable donor skin that is a good texture match for the volar surfaces of the digits. Though further study on skin grafting following fasciectomy for Dupuytren contracture is needed, skin grafting may provide advantages in decreasing disease recurrence through allowing for resection of skin overlying Dupuytren tissue, which may be involved in the disease process, providing a “firebreak” between proximal and distal disease in a digit, and decreasing tension at the wound site.