title: Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren's Contracture: A Prospective, Randomized, Controlled Trial.
abstract: BACKGROUND
  As an alternative to needle aponeurotomy release and limited fasciectomy treatment of Dupuytren's contracture, the authors introduced an extensive percutaneous aponeurotomy and lipofilling (PALF) procedure. In their previous study, the authors reported that contractures significantly improved and most patients returned to normal use of the hand within 2 to 4 weeks. To establish the safety and efficacy of PALF, the authors compared it to the standard limited fasciectomy in a single-blind, multicenter, prospective, randomized, controlled trial.
  
  
  METHODS
  Patients with a primary Dupuytren's contracture were assigned randomly to the limited fasciectomy group or the PALF group. Patients were measured at baseline and at 2 weeks, 3 weeks, 6 months, and 1 year postoperatively. Primary outcome of the trial was contracture correction and convalescence time. Groups were compared using a mixed models approach.
  
  
  RESULTS
  Eighty patients were randomized to PALF or limited fasciectomy. In both groups, almost full metacarpophalangeal joint contracture correction was obtained, whereas for the proximal interphalangeal joint, some residual contracture remained. Patients in the PALF group returned significantly earlier to their normal daily activity. At 1 year after surgery, no significant differences in recurrence rate or hand function were present. However, limited fasciectomy seems to have a higher incidence of permanent complications.
  
  
  CONCLUSIONS
  PALF demonstrates a significantly shorter convalescence, similar operative contracture correction, lower incidence of long-term complications, and no significant difference regarding 1-year postoperative results compared with limited fasciectomy. It is therefore a valuable, minimally invasive alternative to limited fasciectomy in the treatment of Dupuytren's disease.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: Rotterdam, The Netherlands; and Miami, Fla.|From the Department of Plastic and Reconstructive Surgery and Hand Surgery, and the Department of Rehabilitation Medicine and Rijndam, Erasmus University Medical Center; and the Miami Hand Center.
authors.forename: Hester J
authors.initials: HJ
authors.lastname: Kan
authors.affiliation: Rotterdam, The Netherlands; and Miami, Fla.|From the Department of Plastic and Reconstructive Surgery and Hand Surgery, and the Department of Rehabilitation Medicine and Rijndam, Erasmus University Medical Center; and the Miami Hand Center.
authors.forename: Ruud W
authors.initials: RW
authors.lastname: Selles
authors.affiliation: Rotterdam, The Netherlands; and Miami, Fla.|From the Department of Plastic and Reconstructive Surgery and Hand Surgery, and the Department of Rehabilitation Medicine and Rijndam, Erasmus University Medical Center; and the Miami Hand Center.
authors.forename: Christianne A
authors.initials: CA
authors.lastname: van Nieuwenhoven
authors.affiliation: Rotterdam, The Netherlands; and Miami, Fla.|From the Department of Plastic and Reconstructive Surgery and Hand Surgery, and the Department of Rehabilitation Medicine and Rijndam, Erasmus University Medical Center; and the Miami Hand Center.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Rotterdam, The Netherlands; and Miami, Fla.|From the Department of Plastic and Reconstructive Surgery and Hand Surgery, and the Department of Rehabilitation Medicine and Rijndam, Erasmus University Medical Center; and the Miami Hand Center.
authors.forename: Roger K
authors.initials: RK
authors.lastname: Khouri
authors.affiliation: Rotterdam, The Netherlands; and Miami, Fla.|From the Department of Plastic and Reconstructive Surgery and Hand Surgery, and the Department of Rehabilitation Medicine and Rijndam, Erasmus University Medical Center; and the Miami Hand Center.
authors.forename: Steven E R
authors.initials: SER
authors.lastname: Hovius
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D004387:Dupuytren Contracture / Q000601:surgery*; D000071938:Fasciotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D016037:Single-Blind Method; D016896:Treatment Outcome