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DUPUYTRENS DISEASE Michael Mara MD FRCSI FAAOS MAGA DUPUYTRENS - - PowerPoint PPT Presentation
DUPUYTRENS DISEASE Michael Mara MD FRCSI FAAOS MAGA DUPUYTRENS - - PowerPoint PPT Presentation
DUPUYTRENS DISEASE Michael Mara MD FRCSI FAAOS MAGA DUPUYTRENS DISEASE A Systemic Non-Malignant Fibroproliferative Disorder Fibroproliferative Disorder may Affect: The Hand: nodules, cords, Garrods knuckle pads The
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DUPUYTREN’S DISEASE
- A Systemic Non-Malignant
Fibroproliferative Disorder
- Fibroproliferative Disorder may
Affect:
- The Hand: nodules, cords,
Garrod’s knuckle pads
- The Feet: Lederhosen
Syndrome
- The Penis: Peyronei's
Disease
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DUPUYTREN’S DISEASE RISK FACTORS
- Male>>Female
- Caucasian
- Scandinavian/Northern European
Ancestry
- Age>50
- Family History
- Diabetes
- Little Data to support epilepsy, seizure
meds, trauma, industrial
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BARON GUILLAUME DUPUYTREN 1777-1835
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DUPUYTREN’S DIATHESIS
Diat athe hesis sis: a constitutional predisposition toward a particular state or condition Dupuytren’s Diathesis:
- Greater genetic “load” and penetrance
- Aggressive systemic form of the disease
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DUPUYTREN’S DIATHESIS
- <50 years old
- Family History
- Bilateral involvement
- Multiple Digits
- Thumb Involvement
- Ectopic Involvement
- Rapid Progression
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DUPUYTREN’S DIATHESIS
- Very High Recurrence Rates
with traditional treatments
- Careful Patient Counselling
- Very conservative or very
aggressive treatment may be employed
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DUPUYTREN’S CONTRACTURE STAGING
- Stage 0: Normal Hand
- Stage N: Nodule Only
- Stage 1: Contracture 0-45
- Stage 2: Contracture 46-90
- Stage 3: Contracture 91-135
- Stage 4: Contracture >135
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NEEDLE APONEUROTOMY
- Inexpensive
- Low complications rate
- Rapid Recovery
- Local Anaesthesia
- Side Room or Clinic Setting
- High Recurrence Rates (50% at 3 years)
- Expensive
- Minor Wound Complications common
- Serious nerve / artery complications 1%
- Prolonged Recovery
- General / Regional Anaesthesia
- Operating Theatre
- Lowest Recurrence Rates
SURGERY
TREATMENT
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NEEDLE APONEUROTOMY
- Local Anesthesia, Clinic or Side Room Setting
- Multiple Passes through Dupuytren’s Cord with
25g needle
- Minimal Pain,
Very Rapid Recovery
- Can be repeated when needed
- Nerve/Tendon Injury rates < 1%
- Early Recurrence Common
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REGIONAL PALMAR FASCIECTOMY
- Day Surgery or One Night Stay
- Early Hand Therapy for Splinting
and Range of Motion, Edema Control
- Low Recurrence Rates for MP
joint contracture, Moderate Recurrence Rates for PIP joint Contracture
- Note: Collagenase Clostridium
Histolyticum (CCH, Xiapex) Discontinued European Distribution January 2020
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POST-OP CARE
- Surgical Bandages Removed at 72 hours
- Hand Therapy for Thermoplastic Splinting
and
- Early ROM for most cases, delayed 10
days if FTSG
- Suture Removal at 14 days
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WHEN TO REFER: TABLE-TOP TEST
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THANK YOU! ANY QUESTIONS?
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TMTEL.ORG
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