[The lateral-dorsal transposition flap for closure of a palmar soft tissue defect of the proximal phalanx on the little finger after limited fasciectomy in recurrent Dupuytren's contracture]

Abstract

Objective: Closure of a palmar soft tissue defect of the proximal phalanx after limited fasciectomy in recurrent Dupuytren's contracture.

Indications: A palmar soft tissue defect between the distal flexion crease of the palm and the flexion crease of the proximal interphalangeal joint (PIP) after limited fasciectomy in Dupuytren's contracture.

Contraindications: Scars at the lateral-dorsal portion of the proximal phalanx (e.g., after burns).

Surgical technique: Modified incision after Bruner ("mini-Bruner"). Removal of the involved fascial cord. If necessary, arthrolysis of the PIP. Raising the lateral-dorsal transposition flap from distal to proximal and rotating it into the palmar soft tissue defect of the proximal phalanx. Closure of the donor site with a skin transplant.

Postoperative management: Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days. Afterwards static dorsal splint and daily physiotherapy.

Results: Between 2002 and 2007, a total of 32 lateral-dorsal transposition flaps in 30 patients with recurrent Dupuytren's disease of the little finger underwent surgery. In a retrospective study, 19 patients with 20 flaps were available for follow-up evaluation after a mean of 6 years. All flaps had healed. The median flexion contracture of the metacarpophalangeal joint was 0° (preoperatively, 20°), and of the PIP 20° (preoperatively, 85°) according to Tubiana stage 1 (preoperatively, Tubiana stage 3). The median grip strength of both the operated and the contralateral hand was 39 kg. The DASH score averaged 11 points. Overall, 11 patients were very satisfied, 6 patients were satisfied, 1 patient was less satisfied, and 1 patient was unsatisfied.

Keywords: Dupuytren’s disease; Operative treatment; Recurrence; Soft tissue injuries; Transposition flap.