Repeat Limited Fasciectomy is a Safe and Effective Treatment for Dupuytren’s Disease Recurrence

The results of surgery for Dupuytren’s disease can be blighted by the potential for disease recurrence and loss of function. Identifiying those patients who will benefit from repeat surgery, when to operate and what procedure to undertake requires judgement and an understanding of patient expectations and functional needs. We undertook this study to investigate patient outcomes and satisfaction following repeat limited fasciectomy for recurrent Dupuytren’s disease.

We prospectively identified all patients presenting with recurrence of Dupuytren’s disease and selected for surgical treatment with repeat limited fasciectomy surgery. Patients were assessed preoperatively and again at a minimum of 5 years postoperatively. The primary outcome was change in the Michigan Hand Outcomes Questionnaire (MHQ) Score. Secondary outcomes were change in finger range of movement, flexion contracture, Semmes-Weinstein monofilament values and overall satisfaction.

Forty three patients underwent a repeat digital fasciectomy on a total of 54 fingers. There was a significant improvement in Michigan Hand Outcomes Questionnaire scores, across all domains, with a mean overall score increase of 24 points (p<0.0001). Overall the combined flexion contracture across the MCPJ and PIPJ reduced from 72 to 5.6 degrees (p<0.0001). An increase in maximal flexion was seen at the MCPJ (p<0.0001) but not the PIPJ (p=0.55). The mean overall satisfaction score from the visual analogue scale (VAS) was 8.9 (range 7.9 – 10). Complications were uncommon although five fingers showed reduced sensibility at final follow up.

Our study shows that repeat limited fasciectomy for selected patients presenting with recurrence of Dupuytren’s disease can be an effective and safe treatment resulting in excellent patient reported outcomes and levels of satisfaction.