DUPUYTRENS DISEASE Michael Mara MD FRCSI FAAOS MAGA DUPUYTRENS - PowerPoint PPT Presentation

DUPUYTREN’S DISEASE Michael Mara MD FRCSI FAAOS

MAGA

DUPUYTREN’S DISEASE • A Systemic Non-Malignant Fibroproliferative Disorder • Fibroproliferative Disorder may Affect: • The Hand: nodules, cords, Garrod’s knuckle pads • The Feet: Lederhosen Syndrome • The Penis: Peyronei's Disease

DUPUYTREN’S DISEASE RISK FACTORS • Male>>Female • Caucasian • Scandinavian/Northern European Ancestry • Age>50 • Family History • Diabetes • Little Data to support epilepsy, seizure meds, trauma, industrial

BARON GUILLAUME DUPUYTREN 1777-1835

DUPUYTREN’S DIATHESIS Diat athe hesis sis: a constitutional predisposition toward a particular state or condition Dupuytren’s Diathesis: • Greater genetic “load” and penetrance • Aggressive systemic form of the disease

DUPUYTREN’S DIATHESIS • <50 years old • Family History • Bilateral involvement • Multiple Digits • Thumb Involvement • Ectopic Involvement • Rapid Progression

DUPUYTREN’S DIATHESIS • Very High Recurrence Rates with traditional treatments • Careful Patient Counselling • Very conservative or very aggressive treatment may be employed

DUPUYTREN’S CONTRACTURE STAGING • Stage 0: Normal Hand • Stage N: Nodule Only • Stage 1: Contracture 0-45 • Stage 2: Contracture 46-90 • Stage 3: Contracture 91-135 • Stage 4: Contracture >135

TREATMENT NEEDLE APONEUROTOMY SURGERY • Inexpensive • Expensive • Low complications rate • Minor Wound Complications common • Rapid Recovery • Serious nerve / artery complications 1% • Local Anaesthesia • Prolonged Recovery • Side Room or Clinic Setting • General / Regional Anaesthesia • High Recurrence Rates (50% at 3 years) • Operating Theatre • Lowest Recurrence Rates

NEEDLE APONEUROTOMY • Local Anesthesia, Clinic or Side Room Setting • Multiple Passes through Dupuytren’s Cord with 25g needle • Minimal Pain, Very Rapid Recovery • Can be repeated when needed • Nerve/Tendon Injury rates < 1% • Early Recurrence Common

REGIONAL PALMAR FASCIECTOMY • Day Surgery or One Night Stay • Early Hand Therapy for Splinting and Range of Motion, Edema Control • Low Recurrence Rates for MP joint contracture, Moderate Recurrence Rates for PIP joint Contracture • Note: Collagenase Clostridium Histolyticum (CCH, Xiapex) Discontinued European Distribution January 2020

POST-OP CARE • Surgical Bandages Removed at 72 hours • Hand Therapy for Thermoplastic Splinting and • Early ROM for most cases, delayed 10 days if FTSG • Suture Removal at 14 days

WHEN TO REFER: TABLE-TOP TEST

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