Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren's Contracture: A Prospective, Randomized, Controlled Trial
| Autor: | Christianne A. van Nieuwenhoven, Steven E. R. Hovius, Chao Zhou, Roger K. Khouri, Ruud W. Selles, Hester J. Kan |
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| Přispěvatelé: | Plastic and Reconstructive Surgery and Hand Surgery, Rehabilitation Medicine |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Percutaneous media_common.quotation_subject medicine.medical_treatment 030230 surgery law.invention Fasciotomy 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine Humans Single-Blind Method Prospective Studies Dupuytren's contracture Muscle contracture media_common business.industry Convalescence Metacarpophalangeal joint contracture Middle Aged Plastic Surgery Procedures medicine.disease Surgery Dupuytren Contracture Treatment Outcome Adipose Tissue 030220 oncology & carcinogenesis Female Contracture medicine.symptom business Follow-Up Studies |
| Zdroj: | Plastic and Reconstructive Surgery, 137(6), 1800-1812. Lippincott Williams & Wilkins |
| ISSN: | 1529-4242 0032-1052 |
| Popis: | 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. Clinical question/level of evidence Therapeutic, II. |
| Databáze: | OpenAIRE |
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