title: The efficacy of open partial aponeurectomy for recurrent Dupuytren's contracture.
abstract: BACKGROUND
  To evaluate the efficacy of open partial aponeurectomy for recurrent Dupuytren's contracture.
  
  
  METHODS
  Eighteen patients with recurrent Dupuytren's contracture of 22 fingers were retrospectively assessed with a mean follow-up time of 94 months (range: 70-114 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and subjective outcome (disabilities of the arm, shoulder and hand (DASH) questionnaire).
  
  
  METHODS
  Dissection with special regard to former skin incision and expected wound defect. Modified incisions after Bruner (Mini-Bruner incisions) were facilitated. Dissection started at the palm. Fibrous tissue was resected proximally within the palm including vertical fibrotic septae. Direct preparation of the neurovascular bundles (NVB) was facilitated from proximal to distal. If the anatomy of the neurovascular structures became unclear around the natatory ligament preparation of the NVB at the distal end of the fibrous cord was performed. After complete preparation of a NVB, dissection was continued from medial to lateral until the other bundle was completely released. Transposition flaps and skin transplants were often used for sufficient wound closure.
  
  
  RESULTS
  Recurrence rate was 36 % applying the definition of van Rijssen et al. Fifteen patients had a grip strength of 90 % or higher in comparison to the contralateral side. Ten patients had a pinch strength of 90 % or higher in comparison to the contralateral side. All patients except for one had pain reduction or none postoperatively. Fifteen patients had a DASH score of 15 or lower (range: 0-47). An unrelated ray amputation was suffered due to wound healing complications.
  
  
  CONCLUSIONS
  Open partial aponeurectomy performed by a board certified hand surgeon proved to be safe. The postoperative functional outcome seemed to be related to the individual course of the disease.
authors.affiliation: Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany. christianspies27@gmail.com.
authors.forename: Christian K
authors.initials: CK
authors.lastname: Spies
authors.affiliation: Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hahn
authors.affiliation: Department of Orthopaedics and Traumatology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: Lars P
authors.initials: LP
authors.lastname: Müller
authors.affiliation: Department of Orthopaedics and Traumatology, Caritas-Krankenhaus, Uhlandstraße 7, 97980, Bad Mergentheim, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Löw
authors.affiliation: Department of Orthopaedics and Traumatology, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Sellei
authors.affiliation: Department of Orthopaedics and Traumatology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Oppermann
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D004387:Dupuytren Contracture / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D016059:Range of Motion, Articular; D012008:Recurrence; D012189:Retrospective Studies
keywords: Aponeurectomy; Contracture; Dupuytren’s disease; Fasciectomy; Surgical technique