A Retrospective Analysis of Treating Dupuytren's Disease: Acellular Dermal Matrix Following Fasciectomy
Don Hoang, MD, MHS; Patrick Steven, BS; David A. Kulber, MD
University of Southern California, Los Angeles, CA
Various surgical treatment modalities exist for the treatment of Dupuytren disease. However, recurrence rates remain high following surgical treatment which range from 12 to 39%. Previous studies demonstrate recurrence rates as low as 12.2% with use of a full-thickness skin graft and <5% with use of acellular dermal matrix (ADM) as reported by a single study. We desired to further evaluate the use of ADM to reduce recurrence rates based on the postulate that ADM has an inhibitory effect on underlying myofibroblasts. We performed a retrospective cohort study of 68 cases undergoing open fasciectomy for Dupuytren disease from 2007 to 2017. Standard McCash technique fasciectomies of affected palmar and digital fascia were performed. Experimental group patients had a sheet of ADM (FlexHD; Musculoskeletal Transplant Foundation, Edison, NJ) sutured into the surgical bed with absorbable sutures, whereas control group patients were not closed with ADM. They were evaluated at follow-up for disease recurrence, defined as presence of Dupuytren tissue in an area previously operated on with a contracture greater than that recorded following the surgical fasciectomy, or presence of contracture requiring surgery. Among the cohort of 68 cases, 21 (30.0%) were treated with acellular dermal matrix while 47 (70.0%) were not (Table 1). The median age was 67.0 years (range 34 - 86). No statistical difference existed between each group regarding age, comorbidities, and distribution of fingers affected. The mean preoperative IP joint flexion contracture in the ADM group of 68.5¡ ± 28.8¡ was corrected to 8.8¡ ±11.7¡ while the mean MCP joint preoperative flexion contracture of 48.3¡ ± 24.3¡ was corrected to 6.9¡ ± 14.5¡ at postoperative examination (p-value <0.05). The median follow-up was 2.2 years, during which recurrence of contracture was observed in 1 of 21 patients in the group receiving ADM, compared to 10 of 47 in the control group (p-value 0.15). While there was only a trend in lower recurrence rates in the ADM group, there were no differences in the incidence of minor wound complications observed. The adjunct placement of acellular dermal matrix into the wound bed following fasciectomy for Dupuytren disease may be an important surgical strategy to reduce recurrence rates as well as augment coverage of exposed vital structures in cases of severe flexion contracture.
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