[Partial Fasciectomy and Options of Reconstruction Using Local Flaps in Cases of Dupuytren's Disease]

Aim: Partial fasciectomy in cases of grade III-IV Dupuytren's contracture and coverage of the defect with local flaps. Indication: Dupuytren's contracture is a progressive disease of the hand associated with the formation of fascial cords, which may result in flexion and adduction contractures of the fingers leading up to complete dysfunction of the hands. Method: If several fingers are affected, partial fasciectomy is the gold standard in the treatment of Dupuytren's contracture. Ideally, the fingers reach the neutral position after the fibres causing the contracture are resected and arthrolysis is performed as needed. The skin deficits resulting from restored extension have to be covered by the use of Z-plasties, local or pedicled flaps of the hand. Conclusion: The resection of contracting cords in advanced cases of Dupuytren's contracture leads to large soft tissue defects. The microsurgical preparation of nerve and vascular structures is often difficult because of the fascial cords surrounding them. Exact preoperative planning of the extent of resection, as well as reconstruction options are essential and determine how incisions are made. To prevent a relapse, it is essential to reverse skin fibre direction using flaps and to insert intact skin with preserved subdermal adipose tissue.