A modified McCash operation for Dupuytren's contracture

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Plastic Surgery

Background:

• Dupuytren's contracture is a hand deformity causing progressive tightening of the palmar fascia.
• Severe cases with significant skin shrinkage present unique surgical challenges.
• The open palm technique is a surgical approach to address Dupuytren's contracture.

Purpose of the Study:

• To evaluate the efficacy and safety of the open palm technique combined with a midlateral ulnar incision for severe Dupuytren's contracture.
• To assess wound healing and functional outcomes in patients with significant skin shrinkage.

Main Methods:

• The open palm technique was employed in conjunction with a midlateral ulnar incision on the fifth finger.
• This approach was specifically used for selected cases exhibiting severe contracture and skin shrinkage (13% of cases over 2.5 years).
• Particular attention was given to the 'cornerflap' of the incision to monitor for vascular complications.

Main Results:

• No vascular problems were observed following the surgical procedure.
• All surgical wounds healed spontaneously within a 3–6 week period.
• The degree of finger release achieved was comparable to other patient series with similar disease severity.

Conclusions:

• The open palm technique with a midlateral ulnar incision is a viable option for severe Dupuytren's contracture with skin shrinkage.
• This surgical method demonstrates favorable wound healing and functional outcomes.
• The technique is recommended for patients with severe contracture who are in good physical and mental health.