title: [An attempt to objectify the assessment of extension or recurrence of Dupuytren's disease on the basis of ultrasound].
abstract: Dupuytren's contracture is a disease of unknown etiology, leading with time to decreased hand function caused by increasing contracture of fingers. Excision of contracted longitudinal palmar fascia constitutes the most important way of treatment. Due to fact that disease has progressive course in many patients recurrence (i.e. overgrowth of longitudinal palmar aponeurosis apart from the operated site) or extension (i.e. similar process affecting formerly operated site) occurs. An attempt to objectify the assessment of recurrence or extension of Dupuytren's disease on the basis of sonographic examination of palmar surface of the hand during distant (at least 24 months from surgery) followup constituted the aim of the study. 41 patients operated on from January 2000 to February 2009 in 2nd Department of General Surgery in Krakow due to Dupuytren's contracture constituted the study material. Mean age of the patients reached 62,78 years (SD +/- 9,32), and mean follow up time 5,74 years (SD +/- 2,90). Sonographic assessment was performed in 26 operated on left hands and 24 right hands. 9 patients had both hands operated on. In most of the patients during surgery the contralateral hand was also affected by the disease. Extension of Dupuytren's disease was found in 11 hands, recurrence--in 18 hands, while concurrent extension and recurrence was found in 17 hands. Extension usually was found on the radial side and affected mainly I interphalangeal space followed by disease affecting I and III ray of the hand. In one patient 2 independent foci of the disease were found within I interphalangeal space. Recurrences affected mainly ulnar side of the hand: V and IV rays of the hand. Concurrently found extension and recurrence affected 2 or 3 rays. In the cases of 3 rays affected extension dominated (2 rays vs. 1 ray of recurrence). On sonographic assessment mean diameters of lesions during distant follow- up were 12,69 x 4,62 x 3,95 [mm] with recurrent lesions being larger than mean values found in extensions. With partial fasciectomy being the most commonly performed operation in cases of Dupuytren's disease ultrasound can constitute very important technique of assessment of exacerbation of the lesions of palmar aponeurosis allowing for the choice of appropriate surgical technique for particular case, detection of postoperative extension and/or recurrence and for the cases clinically doubtful.
authors.affiliation: Katedra Chirurgii Collegium Medicum UJ, Kraków. mbbanzaj@wp.pl
authors.forename: Marcin
authors.initials: M
authors.lastname: Bednarek
authors.forename: Marek
authors.initials: M
authors.lastname: Trybus
authors.forename: Zdzisław
authors.initials: Z
authors.lastname: Wiśniowski
authors.forename: Piotr
authors.initials: P
authors.lastname: Budzyński
authors.forename: Maksymilian
authors.initials: M
authors.lastname: Gniadek
mesh_terms: D004387:Dupuytren Contracture / Q000000981:diagnostic imaging* / Q000601:surgery; D000071938:Fasciotomy; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006225:Hand / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014463:Ultrasonography