Table 4 - uploaded by Parwez Sajad Khan
Content may be subject to copyright.
Source publication
Dupuytren's disease is one of the fibro-proliferative conditions affecting the palmar and digital fascia. This disease has been known to surgeons and treated by them for at least 200 years. Dupuytren's disease is very common in Northern Europe and also in countries inhabited by immigrants from Northern Europe. Dupuytren's contracture is stated to b...
Context in source publication
Similar publications
This study presents the clinical outcomes of 35 hands with Dupuytren's Disease treated with the McCash technique between 1990 and 2009. Of the 31 patients (28 males and three females, mean age 53 yrs), four patients had bilateral involvement (12.9%). Thirty hands had no previous medical or surgical treatment for the disease, while the remaining fiv...
Objective
to assess the surgical technique using the modified palm open technique for the treatment of severe contractions of Dupuytren's disease.
Methods
over a period of four years, 16 patients under went surgical treatment, and in its entire tybe longed tostages III and IV of the classification proposed by Tubiana et al. We performed measuremen...
Citations
... Complications are not observed even if primary closure is performed using these methods, 1 but a previous report mentioned that skin grafting was required to cover the defect. 2 Additionally, even if a one-stage covering procedure is possible, extending the affected part immediately postoperatively may be difficult due to a strong skin tension. Therefore, covering the defect with a flap was also introduced. ...
Fasciectomy is the standard treatment for Dupuytren's contracture, but, in many cases, skin defects may occur after fasciectomy. If the preoperative contracture is severe, the skin defect is large, which makes covering the defect difficult. We describe a case of severe skin defects after fasciectomy of Dupuytren's contractures in the ring and little fingers covered with multiple digital artery perforator (DAP) flaps . A 58-year-old man with extension restrictions of the ring and little fingers on his left hand was diagnosed with Dupuytren's contracture. The angles of insufficient extension were 70° and 40° for the metacarpophalangeal and proximal interphalangeal joint s, respectively, of the little finger and 42° for the metacarpophalangeal joint of the ring finger. DAP flaps were used to cover the defect on the ring finger's metacarpophalangeal joint and little finger's proximal interphalangeal joint, whereas an ulnar palmar DAP flap was used on the defect on the little finger's metacarpophalangeal joint. The flaps survived without any complications, and, at 6 months postoperatively, satisfactory results were obtained. The extension angles were 0° for the metacarpophalangeal and proximal interphalangeal joints of the little finger and −5° for the ring finger's metacarpophalangeal joint. Such flaps can be designed to fit the width of the skin defect and can be applied to a large skin defect by combining the perforator flaps. Thus, the use of DAP flaps after fasciectomy to cover defects is considered helpful, even in cases of Dupuytren's contracture with severe extension restriction.
... 85% of the patients were satisfied with hand function and the surgery. DASH score before surgery was 20 (17)(18)(19)(20)(21)(22)(23)(24)(25) and after 1 year was found 7 (6-10). ...
... In our series, the intraoperative complication rates compared well with published data. Nerve transections quoted in the literature ranging from 1.5% to 7.8%, while arterial transections found in 0.8% to 9.8%, and infections reported from 1% to 3.4% cases 16,23,24 . Neuropraxia found in 1%-3.7% 16,23,24 . ...
... Nerve transections quoted in the literature ranging from 1.5% to 7.8%, while arterial transections found in 0.8% to 9.8%, and infections reported from 1% to 3.4% cases 16,23,24 . Neuropraxia found in 1%-3.7% 16,23,24 . Moreover, Dias & Braybrooke 25 reviewed the outcomes of surgery in 1177 patients with a clear correlation between incidence of each reported complication and the severity of the initial deformity i.e. a greater deformity had more complications. ...
Background: Dupuytren’s disease is a benign yet disabling, irreversible, progressive fibroproliferative condition affecting the palm and fingers, leading to flection contracture of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints.Objective: To evaluate results of selective fasciectomy to correct the deformity of MCP and PIP joints and observe the complications.Methods: This crosssectional study was done on 30 patients of Dupuytren’s contracture treated by selective fasciectomy, between January 2015 and December 2018, in Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Selective fasciectomy was done under brachial plexus block, tourniquet control and loupe magnification. Brunner zigzag incision was used. Indications for surgery was MCP flection contracture more than 30⁰ and any degree of PIP flection contracture. Postoperatively hand was immobilised in extension of MCP and PIP joints for 2 weeks and then active and passive movements were encouraged and intermittent splinting for 10 weeks (only at night in last 6 weeks).Results: Among 30 patients, 24 (80%) patients were male, 6 (20%) were female; mean age was 62 years (56-74 years). 12 (40%) cases were bilateral, ring and little fingers involvement were seen in most cases (92%). Mean MCP correction was 53⁰ and mean PIP correction was 34⁰ (p<0.001). There were 3 digital nerve injuries peroperatively which were repaired/reconstructed and protective sensation regained in repaired nerve area at 1 year and 3 (10%) marginal skin loss postoperatively which healed secondarily. Superficial wound infection developed in 3 (10%) patients which healed on dressing and antibiotics. Complex regional pain syndrome developed in 2 (6.66%) patients which were mild and resolved on conservative management. 3 (10%) patients developed scar sequilae which were mild and resolved on conservative treatment. Radial digital artery injury was observed in 1 (3.33%); however, no ischaemic insult was observed postoperatively. 2 (6.66%) patients developed recurrence of the disease who were more than 70 years old; however, they declined further intervention.Conclusion: Selective fasciectomy is an easy and effective procedure with less complication to correct the deformities and improve the gripstrength significantly in Dupuytren’s contracture patients.International Journal of Human and Health Sciences Vol. 06 No. 01 January’22 Page: 41-46
... 9 In a study by Khan et al patients were categorized into 3 stages, Stage I is presence of a thickened nodule and band in the palmar aponeurosis and often associated with skin puckering, stage II is stage I plus limitation of extension and stage III is stage II plus flexion contracture. 11 Surgical fasciectomy is a documented effective treatment method, but complications such as digital neurovascular injury and wound-related problems are common. [8][9][10][11][12] Limited fasciectomy (LF) has proven to be curative and effective and most commonly performed of the surgical interventions. ...
... 11 Surgical fasciectomy is a documented effective treatment method, but complications such as digital neurovascular injury and wound-related problems are common. [8][9][10][11][12] Limited fasciectomy (LF) has proven to be curative and effective and most commonly performed of the surgical interventions. 12 Denkler et al reported that the limited fasciectomy technique has the lowest recurrence rate out of all surgical and non-surgical methods and is currently the most popular technique used. ...
Dupuytren’s disease is a fibro-proliferative condition affecting the palmar and digital fascia. This disease is very common in Northern Europe but in India it uncommon as there are only a few cases reported, hence also called as ‘Viking Disease’. Surgical fasciectomy is the standard surgical treatment of choice for Dupuytren’s disease. Complications following surgery are high but there is no definitive cure for Dupuytren disease (DD), and recurrence of finger contractures after treatment is common.
... All patients signed a free and informed consent form. Patients were staged according to system by Khan et al.13 ...
OBJECTIVE
To present the results of our cases of Dupuytren's disease treated with regional selective fasciectomy in light of the literature.
METHODS
Patients diagnosed with Dupuytren's contracture and surgically treated with regional selective fasciectomy at our institution with adequate follow-up data were included in the study. All patients were routinely followed after surgery to assess results and complications. QuickDASH scoring was used to evaluate the patients and recurrences and complications were recorded.
RESULTS
Twenty-one hands of 19 patients (13 males, 6 females) who underwent surgery and received adequate follow-up were retrospectively evaluated. Mean patient age was 65.8 (range: 41 to 86) and the mean follow-up period was 48.2 months (range: 24 to 86). Fourteen (66.6%) hands had excellent results, five (23%) hands had good results and two (9.4%) had fair results. The mean QuickDASH score for the patients at the final follow-up was 6.58 (range: 0 to 20.4).
CONCLUSION
Our study results demonstrated that regional selective fasciectomy is a reliable and efficient method to treat Dupuytren's disease with low rates of complications and recurrence and the technique can be considered the gold standard. Level of Evidence IV, Case Series.
... A recently developed diseasespecific questionnaire, Unité Rhumatologique de Affections de la Main scale (URAM), was utilised by one study [15] and 8 used other self-report measures such as return to work or self-rated disability. A further 5 reported the use of function PROMs but did not present the results [16][17][18][19][20]. The use of PROMs is summarised in Figure 1. ...
Background
Dupuytren's disease of the hand is a common condition affecting the palmar fascia, resulting in progressive flexion deformities of the digits and hence limitation of hand function. The optimal treatment remains unclear as outcomes studies have used a variety of measures for assessment.
Methods
A literature search was performed for all publications describing surgical treatment, percutaneous needle aponeurotomy or collagenase injection for primary or recurrent Dupuytren’s disease where outcomes had been monitored using functional measures.
Results
Ninety-one studies met the inclusion criteria. Twenty-two studies reported outcomes using patient reported outcome measures (PROMs) ranging from validated questionnaires to self-reported measures for return to work and self-rated disability. The Disability of Arm, Shoulder and Hand (DASH) score was the most utilised patient-reported function measure (n=11). Patient satisfaction was reported by eighteen studies but no single method was used consistently. Range of movement was the most frequent physical measure and was reported in all 91 studies. However, the methods of measurement and reporting varied, with seventeen different techniques being used. Other physical measures included grip and pinch strength and sensibility, again with variations in measurement protocols. The mean follow-up time ranged from 2 weeks to 17 years.
Conclusions
There is little consistency in the reporting of outcomes for interventions in patients with Dupuytren’s disease, making it impossible to compare the efficacy of different treatment modalities. Although there are limitations to the existing generic patient reported outcomes measures, a combination of these together with a disease-specific questionnaire, and physical measures of active and passive individual joint Range of movement (ROM), grip and sensibility using standardised protocols should be used for future outcomes studies. As Dupuytren’s disease tends to recur following treatment as well as extend to involve other areas of the hand, follow-up times should be standardised and designed to capture both short and long term outcomes.
Journal of Macedonian Association of Orthopedics and Trauma
La enfermedad de Dupuytren es una afección fibroproliferativa cuya etiología exacta se desconoce. Se produce hacia los 60 años y se expresa esencialmente en varones. Su prevalencia es elevada en poblaciones originarias del norte de Europa y sus descendientes. Comienza por formaciones nodulares y puede causar un engrosamiento y una retracción de las estructuras fibrosas palmares fisiológicas, con constitución de bridas fibrosas que provocan una flexión progresiva e irreductible de las articulaciones digitales. Su fisiopatología es multifactorial y en ella intervienen factores genéticos, ambientales y generales. La enfermedad evoluciona en tres fases: proliferativa (caracterizada por la proliferación de fibroblastos y la presencia de colágeno inmaduro), involutiva (con orientación de los miofibroblastos y del colágeno según las líneas de tensión) y residual (con pocas células y un colágeno maduro de orientación uniforme). Dado que no existe un tratamiento etiológico, el tratamiento es únicamente sintomático. Debido a su carácter poco invasivo, a su tasa baja de complicaciones y a una recuperación funcional rápida, la fasciotomía percutánea con aguja debe proponerse como primera elección. Es menos eficaz sobre la interfalángica proximal (IFP) que sobre la metacarpofalángica, tanto sobre la corrección como sobre la recidiva del flexo, en particular en individuos jóvenes. La cirugía es el tratamiento de referencia, porque es el que más retarda una posible recidiva, pero a costa de una tasa elevada de complicaciones y de un postoperatorio prolongado. La fasciectomía es el procedimiento terapéutico que más se realiza en la actualidad. El objetivo es realizar una resección lo más completa posible de los tejidos patológicos, obtener una corrección completa de la retracción, a costa de una artrólisis de la IFP si es preciso, y suprimir cualquier tensión cutánea. A pesar de las recidivas y las extensiones de la enfermedad, la mayoría de los pacientes conserva un beneficio funcional después de más de 10 años.
Giant-cell tumor (GCT) is a benign neoplasm appearing
approximately in 20% of benign primary bone tumors.
Yet, literature confirms that 7% of all GCT are primarily
malignant nature. This tumor typically affects the
epiphyseal region of femur, tibia, and humerus while
its occurrence in the bones of the hand is rare. It occurs
between the second and the fourth decade of life, with
a slight prevalence in women. This lesion is typically
presented with pain, swelling and limitation of joint
movement. We present two cases of aggressive GCT of
the hand with serious outcome. The first one is a case of
a 34-year old male; with aggressive GCT of the proximal
phalanx of the left thumb and the second one is a case
report of a 39-year female patient with aggressive GCT
of the proximal phalanx of the right thumb.
Key words: Giant cell tumor, hand
We present a patient with a combination of four allergic diseases - rhinitis, conjunctivitis, urticaria and angioneurotic edema along with other concomitant problems with objectified or suspected allergic pathogenesis. The cases of simultaneous presentation of allergic diseases in one and the same individual are not uncommon in practice. Most often, it refers to the inclusion of another syndrome or symptom from another organ/system in the allergic process with the already diagnosed allergic disease in the background. A typical example of that is the proven higher risk of developing asthma when there has been allergic rhinitis diagnosed, especially in juvenile and young patients. We reckon that the presented case would draw attention not only with the number but also with the variety of symptoms of registered allergic syndromes. Nowadays and in the near future, the likelihood of this type of combined allergic pathology getting more common is substantial, considering the increasing number and variety of environmental factors, influencing the immune system on one hand, and the relationship of those factors with the unique in its essence phenomenon called atopy and with the individual reactivity of each organism, on the other.
