Dupuytren's contracture: clinical and therapeutic aspects

The writers first describe the main features of the pathological anatomy and clinical characteristics of Dupuytren's contracture. They classify the lesions by Tubiana's method, which is eminently objective and practical. This classification divides the lesions, according to their severity, in five stages: 0, 1, 2, 3, 4. The surgical technique of total aponeurectomy used by the authors is described. The total case material is thirty patients, with thirty-three hands operated on. By comparing the state of the hand before and after operation, the degree of improvement was calculated as a percentage derived from Tubiana's method of classification. A careful evaluation of the results confirms the validity of the therapeutic approach adopted. The indications and prognosis depend on the severity of the initial lesions. In general the chances of cure are good up to stage 3; but once this stage has been passed, and especially if hyperextension of the terminal phalanx is present, there is a high probability of recurrence and failure. In these cases they advise against corrective surgery and consider arthrodesis or amputation a more suitable alternative.