3-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren’s surgery
Background Numerous Dupuytren’s fasciectomy techniques have been described, each associated with unique surgical challenges, complications and recurrence rates. We describe a common ground surgical approach to Dupuytren’s disease; 3-dimensional fasciectomy (3DF). 3DF aims to address the potential c...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2018-11-01
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| Series: | Archives of Plastic Surgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2016.02131 |
| _version_ | 1798005742905589760 |
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| author | Benjamin H Miranda Charlotte Elliott Christopher C Kearsey David N Haughton Mark R Webb Ian Harvey Fahmy S Fahmy |
| author_facet | Benjamin H Miranda Charlotte Elliott Christopher C Kearsey David N Haughton Mark R Webb Ian Harvey Fahmy S Fahmy |
| author_sort | Benjamin H Miranda |
| collection | DOAJ |
| description | Background Numerous Dupuytren’s fasciectomy techniques have been described, each associated with unique surgical challenges, complications and recurrence rates. We describe a common ground surgical approach to Dupuytren’s disease; 3-dimensional fasciectomy (3DF). 3DF aims to address the potential contributors to the high recurrence rate of Dupuytren’s disease and unite current limited fasciectomy practice that varies considerably between surgeons.
Methods We describe the 3DF principles; raising thin skin flaps (addressing dermal involvement), excising diseased palmar fascia with a 3−5 mm clearance margin (treating highly locally recurrent conditions) and excising the vertical septae of Legueu and Juvara (providing deep clearance, hence addressing all potentially involved pathological tissue). The surgical outcomes between traditional limited fasciectomy (LF) and 3DF are compared.
Results From the 786 operations included (n=585), postoperative recurrence rates were significantly lower for the 3DF group (2/145, 1.4%) than the LF group (72/641, 11.2%) (P=0.001), and the time to recurrence was significantly longer (5.0±0 years vs. 4.0±0.2 years; P<0.0001). With recurrence excluded, there were no differences between the postoperative complication rates for 3DF (5/145, 3.5%) and LF (41/641, 6.4%) (P=0.4).
Conclusions Our results suggest that 3DF leads to lower recurrence rates and a longer disease-free period for patients, without increasing complications. 3DF provides a safe, efficacious, common ground surgical approach in the treatment of Dupuytren’s flexion deformity. |
| first_indexed | 2024-04-11T12:43:55Z |
| format | Article |
| id | doaj.art-1a9811074c1f4ab18ffec54c0cfb1d44 |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-11T12:43:55Z |
| publishDate | 2018-11-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-1a9811074c1f4ab18ffec54c0cfb1d442022-12-22T04:23:24ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712018-11-01450655756310.5999/aps.2016.021319803-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren’s surgeryBenjamin H Miranda0Charlotte Elliott1Christopher C Kearsey2David N Haughton3Mark R Webb4Ian Harvey5Fahmy S Fahmy6Department Plastic and Reconstructive Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UKDepartment Plastic and Reconstructive Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UKDepartment Plastic and Reconstructive Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UKDepartment Plastic and Reconstructive Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UKDepartment Orthopaedic Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UKDepartment Plastic and Reconstructive Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UKDepartment Plastic and Reconstructive Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UKBackground Numerous Dupuytren’s fasciectomy techniques have been described, each associated with unique surgical challenges, complications and recurrence rates. We describe a common ground surgical approach to Dupuytren’s disease; 3-dimensional fasciectomy (3DF). 3DF aims to address the potential contributors to the high recurrence rate of Dupuytren’s disease and unite current limited fasciectomy practice that varies considerably between surgeons. Methods We describe the 3DF principles; raising thin skin flaps (addressing dermal involvement), excising diseased palmar fascia with a 3−5 mm clearance margin (treating highly locally recurrent conditions) and excising the vertical septae of Legueu and Juvara (providing deep clearance, hence addressing all potentially involved pathological tissue). The surgical outcomes between traditional limited fasciectomy (LF) and 3DF are compared. Results From the 786 operations included (n=585), postoperative recurrence rates were significantly lower for the 3DF group (2/145, 1.4%) than the LF group (72/641, 11.2%) (P=0.001), and the time to recurrence was significantly longer (5.0±0 years vs. 4.0±0.2 years; P<0.0001). With recurrence excluded, there were no differences between the postoperative complication rates for 3DF (5/145, 3.5%) and LF (41/641, 6.4%) (P=0.4). Conclusions Our results suggest that 3DF leads to lower recurrence rates and a longer disease-free period for patients, without increasing complications. 3DF provides a safe, efficacious, common ground surgical approach in the treatment of Dupuytren’s flexion deformity.http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2016.02131dupuytren contracturefasciarecurrencehandfasciectomy |
| spellingShingle | Benjamin H Miranda Charlotte Elliott Christopher C Kearsey David N Haughton Mark R Webb Ian Harvey Fahmy S Fahmy 3-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren’s surgery Archives of Plastic Surgery dupuytren contracture fascia recurrence hand fasciectomy |
| title | 3-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren’s surgery |
| title_full | 3-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren’s surgery |
| title_fullStr | 3-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren’s surgery |
| title_full_unstemmed | 3-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren’s surgery |
| title_short | 3-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren’s surgery |
| title_sort | 3 dimensional fasciectomy a highly efficacious common ground approach to dupuytren s surgery |
| topic | dupuytren contracture fascia recurrence hand fasciectomy |
| url | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2016.02131 |
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