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Five-Year Results of a Randomized Clinical Trial on Treatment in Dupuytren's Disease: Percutaneous Needle Fasciotomy versus Limited Fasciectomy

van Rijssen, Annet L. M.D.; ter Linden, Hein M.D.; Werker, Paul M. N. M.D., Ph.D.

Plastic & Reconstructive Surgery: February 2012 - Volume 129 - Issue 2 - p 469–477
doi: 10.1097/PRS.0b013e31823aea95
Hand/Peripheral Nerve: Original Articles
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Background: The increasing number of methods for treating Dupuytren's disease indicates a need for comparative studies. In this article, the 5-year follow-up results of a randomized controlled study that compared percutaneous needle fasciotomy and limited fasciectomy are presented.

Methods: One hundred eleven patients with 115 affected hands with a minimal passive extension deficit of 30 degrees were assigned randomly to the two groups. Follow-up examinations were performed at 1 and 6 weeks; 6 months; and 1, 2, 3, 4, and 5 years. Outcome parameters were total passive extension deficit, patient satisfaction, flexion, and sensibility. Furthermore, disease extension was recorded. The primary endpoint was recurrence, defined as an increase of total passive extension deficit of greater than 30 degrees. Ninety-three patients reached this endpoint.

Results: The recurrence rate after 5 years in the needle fasciotomy group (84.9 percent) was significantly higher than in the limited fasciectomy group (20.9 percent) (p < 0.001), and occurred significantly sooner in the needle fasciotomy group (p = 0.001). Older age at the time of treatment decreased the recurrence rate (p = 0.005). No other diathesis characteristics influenced recurrence. Patient satisfaction was high in both groups but was significantly higher in the limited fasciectomy group. Nevertheless, many patients (53 percent) preferred percutaneous needle fasciotomy in case of recurrence.

Conclusions: Percutaneous needle fasciotomy is the preferred treatment for elderly patients with Dupuytren's disease and for those willing to accept a possible early recurrence in the context of the advantages, such as fast recovery, a low complication rate, and minimal invasiveness.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Zwolle and Groningen, The Netherlands

From the Department of Plastic, Reconstructive and Hand Surgery, Isala Clinics, and the Department of Plastic Surgery, University Medical Centre Groningen, and the University of Groningen.

Received for publication January 25, 2011; accepted July 25, 2011.

Presented in part at the International Symposium on Dupuytren's Disease, in Miami, Florida, May 22 through 23, 2010; the 21st Annual European Association of Plastic Surgeons Meeting, in Manchester, United Kingdom, May 27 through 29, 2010; the Spring Meeting of the British Society for Surgery of the Hand, in Manchester, United Kingdom, March 31, 2011; and the 16th Congress of the Federation of the European Society for Surgery of the Hand, in Oslo, Norway, May 26 through 28, 2011.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Annet L. van Rijssen, M.D.; Department of Plastic, Reconstructive and Hand Surgery, Isala Clinics, Dr. van Heesweg 2, 8025 AB Zwolle, The Netherlands, annetvanrijssen@hotmail.com

©2012American Society of Plastic Surgeons