デュピュイトラン拘縮に対する選択的筋膜切開術と局所皮弁介在術：後向き解析

Dupuytren contracture is a fibroproliferative disorder that causes progressive flexion deformities of the fingers. Various traditional procedures have distinct benefits and limitations. We developed a novel surgical technique combining selective fasciotomy with local flap interposition to restore extension while preventing pathological reconnection.

This study adhered to the STROBE guidelines. A retrospective review was conducted on 64 patients (90 fingers; average age, 68.1 years) treated between 2011 and 2024 at two institutions with expertise in hand surgery. Pathological cords were selectively divided through one to three transverse incisions according to the site of contracture. Skin defects were covered with digitolateral or ulnar parametacarpal flaps, which physically interposed between the divided fascial ends. Active extension of the metacarpophalangeal and proximal interphalangeal joints was measured preoperatively and at follow-up visits to assess surgical outcomes and recurrence.

All flaps survived and no major complications, such as hematoma, infection, skin necrosis, or neurovascular injury, were observed. At 6 months postoperatively, 90.7% of metacarpophalangeal joints and 61.7% of proximal interphalangeal joints maintained extension within -5° of full extension. Among the 23 fingers followed for more than 2 years, no apparent tendency toward recurrence was observed.

This technique achieved favorable clinical outcomes with minimal complications. Selective division combined with local flap interposition may effectively reduce the risk of fascial reconnection and early recurrence. Further long-term studies are warranted to confirm the durability of these results and refine the indications for this approach.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, Ⅳ.