title: Multiple Recurrences in Aggressive Forms of Dupuytren's Disease-Can Patients Benefit from Repeated Selective Fasciectomy?
abstract: BACKGROUND
  In Dupuytren's disease (DD), limited fasciectomy is the mainstay of surgical therapy in patients at risk of contractures and disease recurrences. New minimally invasive treatments such as injection of collagenaseclostridium histolyticumhave evolved as a common tool for the preliminary treatment of Dupuytren's contractures. However, recurrences and their therapy remain controversial. In this study, we evaluate the benefit of repeated limited fasciectomy in patients with aggressive forms of the disease and multiple recurrences of contractures.
  
  
  METHODS
  We evaluated the outcome of 16 patients undergoing limited fasciectomy 3 or more times on a single hand.
  
  
  RESULTS
  Postoperatively, 10 of 13 (76.9%) patients were satisfied with the clinical result after the last operation; 10 of 12 (83.3%) patients would choose to have their surgery repeated, if so needed. The mean improvement of proximal interphalangeal joint range of motion was 59.2 degrees (SD 26.8) and 86.2% (SD 19.9). There were no severe complications after treatment within the observed time period.
  
  
  CONCLUSIONS
  Our findings demonstrate that patients with recurrence of contractures after multiple previous treatments in aggressive forms of DD can benefit from surgical intervention. In conclusion, repeated limited fasciectomy remains indicated in patients after previous surgeries with DD.
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany; and Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, AGAPLESION Diakonieklinikum Rotenburg, Rotenburg (Wümme), Germany.
authors.forename: Sören
authors.initials: S
authors.lastname: Könneker
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany; and Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, AGAPLESION Diakonieklinikum Rotenburg, Rotenburg (Wümme), Germany.
authors.forename: G Felix
authors.initials: GF
authors.lastname: Broelsch
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany; and Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, AGAPLESION Diakonieklinikum Rotenburg, Rotenburg (Wümme), Germany.
authors.forename: Nicco
authors.initials: N
authors.lastname: Krezdorn
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany; and Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, AGAPLESION Diakonieklinikum Rotenburg, Rotenburg (Wümme), Germany.
authors.forename: Khaled
authors.initials: K
authors.lastname: Dastagir
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany; and Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, AGAPLESION Diakonieklinikum Rotenburg, Rotenburg (Wümme), Germany.
authors.forename: Jörn W
authors.initials: JW
authors.lastname: Kuhbier
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany; and Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, AGAPLESION Diakonieklinikum Rotenburg, Rotenburg (Wümme), Germany.
authors.forename: Felix J
authors.initials: FJ
authors.lastname: Paprottka
authors.affiliation: Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany; and Department of Plastic, Aesthetic and Reconstructive Surgery, Hand Surgery, AGAPLESION Diakonieklinikum Rotenburg, Rotenburg (Wümme), Germany.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Vogt