Expanded Dermofasciectomies and Full-Thickness Grafts in the Treatment of Dupuytren’s Contracture: A 36-Year Experience

Abstract

Purpose: Dupuytren’s disease frequently results in crippling deformities of the hands and has a high incidence of recurrence after limited fasciectomy. We report a 36-year experience with full-thickness grafts to resurface defects created by releasing Dupuytren’s contractures with dermofasciectomies.

Methods: Dermofasciectomy and full-thickness skin grafts were used in 153 patients on 204 hands with Dupuytren’s contractures from 1970 to 2005.

Results: In the first part of the study, 36 hands in 24 patients were followed for an average of 3.9 years postoperatively between 1970 and 1985. There was no recurrent disease in the areas in the palms or digits covered by the full-thickness grafts. The incidence of extension outside the grafts was 8.3%. Were these results realistic and do they reflect the benefits of expanded grafts to reduce the incidence of recurrence and extension? To address that question, an additional cohort of patient was studied from 1985 to 2005. An additional 168 hands in 129 patients were treated with the same procedure and followed an average of 2.8 years postoperatively. Again, there was no recurrent disease in the areas of the palms or digits that had been covered by the grafts and the extension rate was comparable at 9.5%.

Conclusions: This study of 204 hands demonstrates the validity of using dermofasciectomy and full-thickness grafts in the treatment of patients with Dupuytren’s contracture who are likely to develop recurrent disease.