Dupuytren's contracture -- surgery of recurrencies

The present study is a retrospective investigation of patients who underwent surgery for recurrence of Dupuytren's contracture. We discuss the indications for this intervention, operative methods, and postoperative therapy. Surgical treatment for recurrence of this condition is incomparably more difficult and risky than the primary operation. At the Innsbruck University Clinic for Plastic and Reconstructive Surgery, 50 patients underwent 70 operations for treatment of recurrence of Dupuytren's contracture between March 1999 and September 2004. Thorough pre- and postoperative clinical investigations and assessment of hand status as well as analysis of the indication for the first operation and the surgical method used were carried out. All patients underwent intensive postoperative hand therapy from day 1 for restoration of function and flexibility. After completion of therapy, in 32 patients there was an improved ROM of between 40 and 270 degrees per finger, in five patients an unchanged ROM, and in three patients, reduction in ROM by 5 to 58 degrees; six patients failed to show up for their follow-up despite being asked to do so several times. No data are as yet available on four patients who had undergone primary operation elsewhere and were operated within the past six months for recurrence in our clinic. In nine patients, there was a decrease in sensation immediately after surgery; but improvement was achieved within six months in three of these patients after intensive hand therapy. Careful assessment of hand function, establishing the indications for surgery at the right time, choice of the appropriate surgical approach and initiation of intensive hand therapy immediately after surgery are decisive for effective treatment of recurrent Dupuytren's contracture. However, amputations and ray resections cannot be avoided in all cases, especially if nerve injuries incurred during previous operations, resulting in joint stiffness.