BACKGROUND:
Dupuytren’s disease affects 3-6% of the global Caucasian population. Recurrence of disease after fasciectomy remains a difficult problem, with studies citing an incidence between 63% and 71%. Although the etiology of the disease remains elusive, studies have implicated myofibroblast contraction as a key component of the mechanism. It has also been shown that disease rarely occurs beneath full-thickness skin grafts. In addition, data presented at the 2008 NESPS meeting showed that the presence of acellular dermal matrix inhibited the formation of myofibroblast-laden capsules in an African green monkey experimental model (Stump et al., NESPS, 2008.). Based on these results, we postulate that the presence of acellular dermal matrix may have an inhibitory effect on the differentiation of and/or function of myofibroblasts, and may therefore reduce recurrence after faciectomy for Dupuytren's disease.
METHODS:
All patients undergoing fasciectomy for Dupuytren’s disease during a 3 year span were analyzed, for a total of 40 operations on 34 patients. Standard fasciectomies of the affected palmar and digital fascia were performed via Brunner incisions on all patients. In the experimental group (n = 16 patients), a sheet of acellular dermal matrix corresponding to the size of the excised fascia was sutured into the surgical bed with interrupted absorbable sutures prior to closure. Patients were evaluated at follow up for residual contracture and disease recurrence.
RESULTS:
Median follow-up was 38 days for the control group, and 45 days for the acellular dermal matrix group. There were no intraoperative complications in either group. Postoperatively, recurrent contracture was noted in 5/18 patients in the control group, and 1/15 patients in the acellular dermal matrix group. This incidence of minor wound complications in both groups was identical.
CONCLUSIONS:
We describe a novel technique involving the placement of acellular dermal matrix into the wound bed after fasciectomy for Dupuytren’s disease. This technique did not result in an increase in adverse outcomes in this pilot series of patients, and demonstrated a trend towards decreased incidence of recurrent disease.