Dupuytren’s contracture is a disorder of the triangular structure of fibers inside the palm. There are multiple procedures that are proven to be effective in the treatment of this disease, such as dermofasciectomy, open and needle fasciotomy, and segmental or limited fasciectomy.1 While a number of new options have been proposed, none of them are aiming to cure the root cause.1 This review discusses the article “Dupuytren’s Disease: Limited Fasciectomy, Night Splinting, and Hand Exercises — Long-term Results” by Kitridis et al., its purpose, primary arguments, and presented evidence.
The paper provides the latest information on the approved or potentially efficient methods of treatment of Dupuytren’s disease. The authors argue that the lack of a gold standard protocol is harmful to patients who receive non-optimal treatment which imposes higher chances of recurrence.1 There is a definite need for a unified method that would cover all the necessary surgical and post-surgical procedures and recommendations. The paper aims to provide the sufficient combination of treatment options for all hand surgeons worldwide.
Complications regarding Dupuytren’s contracture are not the only issue by the authors. The purpose of this article is to decide which treatment methods lead to the best possible results and to synthesize “a viable protocol which reduces the rates of recurrence of DC”.1 In their in-depth research of this topic, the authors propose a set of the most optimal methods according to the evidence at hand.
The authors claim that these changes are necessary in order to reduce the occurrence of Dupuytren’s disease after the initial treatment. Current evidence contradicts the efficiency of post-surgical protocols regarding recurrence rates.1 To support this claim, they provide evidence in the form of statistics on changes in patient outcomes. The authors gathered data from thirty cases of Dupuytren’s contracture in order to review the recurrence rates of a specific treatment protocol that was used in all presented examples.1 Moreover, they have provided available information from researches similar to theirs, which proves their point.
The study by Kitridis et al. shows that “limited fasciectomy followed by a 24-week night splint application, combined with home hand exercises,” reduces the recurrence rates of Dupuytren’s contracture by 40% in male patients and up to 70% in females.1 In order to compare the average recurrence rates of this disease in patients who underwent other treatment protocols, data on their changes in the post-surgical condition is also included. It shows that patients who had open fasciotomy report a 45% recurrence rate, segmental fasciectomy results in a 38% recurrence rate, and dermofasciectomy shows a 34% recurrence rate at the average mean of 5 years.1 There is an assumption in one of the studies that was used in these statistics where researchers did not report any specifics about night splinting.1 Nonetheless, this combined data allows the reader to compare the efficiency of the proposed unified protocol with other regularly applied methods.
I agree with the findings and the necessity of this research, especially in the light of the statistics provided by the authors. Hoang et al. state that “recurrence rates following surgical intervention for Dupuytren’s disease (DD) remains high”.2 The disease itself is a common disorder in senior Caucasian males, yet preventing its recurrence remains a challenge.1 The introduction of a viable treatment protocol can alleviate the situation, considering that the current methods are unable to guarantee absolute success.
Reference List
1 – Kitridis D, Karamitsou P, Giannaros I, Papadakis N, Sinopidis C, Givissis P. Dupuytren’s disease: limited fasciectomy, night splinting, and hand exercises-long-term results. Eur J Orthop Surg Traumatol. 2019;29(2):349-355.
2 – Hoang D, Steven P, Chen VW, Stasiak A, Cohen M, Kulber DA. Use of acellular dermal matrix following fasciectomy for the treatment of Dupuytren’s disease. Plast Reconstr Surg Glob Open. 2019;7(5):e2263.