Lermusiaux_newsubbed.qxp 19/5/09 3:14 pm Page 18
Dupuytren’s Contracture
In Peyronie’s disease (1% association with Dupuytren’s), fibrosis
locates on the tunica albuginea of the penis. The diagnosis is easily Jean-Luc Lermusiaux is the Associate Practician
made in the presence of Dupuytren’s contracture, with the patient
Consultant at l’Unité Rhumatologique des Affections de
la Main, Lariboisière Teaching Hospital. He is also
describing an acquired angulation of his penis when it is erect.
President of the Association for the Study and Non-
Three injections of prednisolone acetate strictly into the nodule at surgical Treatment of Dupuytren’s Contracture (ENTC
three-week intervals and treatment with 1mg colchicine daily
Dupuytren). Dr Lermusiaux is the inventor of needle
aponeurotomy and has trained rheumatologists and
for three months results in a 50% rate of good results.
surgeons from France, other European countries and
the US. He is renowned as a specialist in the field of
Conclusions
hand affections.
Dupuytren’s contracture is a frequent affliction and can lead
Sophie Lahalle is a Rheumatologist in the Internal
to progressive disability. Surgical treatment is aimed at advanced
Medicine and Rheumatology Department of La Croix
stages,
29
requires several weeks of convalescence
30
and carries Saint Simon Hospital. She was trained in needle
important risks of complications and reoccurrence. In trained
aponeurotomy at the Unité des Affections
Rhumatologiques de la Main of Lariboisière Teaching
medical hands, NA is a safe technique that can be used at earlier
Hospital. She is Vice President of the Association for the
stages and bring immediate results. In cases of recurrence, Study and Non-surgical Treatment of Dupuytren’s
treatment can be repeated. Therefore, NA emerges as a first-
Contracture (ENTC Dupuytren).
line treatment. ■
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2. Hindocha S, et al., Hand, 2009; in press. 14. Lermusiaux JL, et al., Rev Rhum Engl Ed, 1997;64: 24. Beaudreuil J, et al., Congrès de la Société Française de
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4. Murrell GA, Hand Clin, 1991;7:669–80. 15. Badois FJ, et al., Rev Rhum Ed Fr, 1993;60:808–13. 25. Lellouche H, Presse Med, 2008;37:1779–81.
5. Tomasek JJ, et al., Hand Clin, 1999;15:21–34. 16. Badalamente MA, Hurst LC, J Hand Surg Am, 26. van Rijssen AL, et al., J Hand Surg Am, 2006;31:
6. Murrell GA, Ann Chir Main Memb Super, 1992;11:355–61. 2007;32:767–74. 717–25.
7. Johnston P, et al., J Hand Surg, 2007;32:343–51. 17. Hurst LC, Badalamente MA, Hand Clin, 1999;15:97–107. 27. Lermusiaux JL, et al., La main rhumatologique, 2002:
8. Johnston P, et al., J Hand Surg Am, 2008;33:1160–67. 18. Hindocha S, et al., Hand, 2008;3:80–86. Med-Line editions.
9. Murrell GA, et al., Br Med J Clin Res Ed, 1987;295:1373–5. 19. Makela EA, et al., J Hand Surg Br, 1991;16:272–4. 28. Hindocha S, et al., J Hand Surg Am, 2006;31:1626–34.
10. Lermusiaux JL, et al., La main rhumatologique, 2002;63–7. 20. Prosser R, Conolly WB, J Hand Ther, 1996;9:344–8. 29. Au-Yong IT, et al., Tech Hand Up Extrem Surg, 2005;9:
11. Urban M, et al., J Hand Surg Br, 1996;21:112–16. 21. Anwar MU, et al., J Hand Surg Am, 2007;32:1423–8. 178–87.
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13. Swartz WM, Lalonde DH, Plast Reconstr Surg, 2008;121: Med-Line editions.
Editor’s Recommendations
Histological Staging and Dupuytren’s Disease fingers was similar in the two groups and both were comparable
Recurrence or Extension after Surgical Treatment: in terms of grip strength, range of movement and disability at each
A Retrospective Study of 124 Patients follow-up. The article concludes that the recurrence rate was
Balaguer T, et al., J Hand Surg Eur, 2009;24 (Epub ahead of print).
12.2%. We did not identify any improvement in correction or
The article discusses Dupuytren’s disease and how it has a high recurrence of contracture after firebreak ermofasciectomy up to
rate of recurrence after treatment. The study focuses on the three years after surgery. ■
usefulness of histological staging in the prediction of recurrence
and how there is a significant difference in the recurrence rate Visual and Computer Software-aided
between the three histological types (p=0.04). Histological staging Estimates of Dupuytren’s Contractures:
was independent of features of Dupuytren’s diathesis. The article Correlation with Clinical Goniometric Measurements
concludes that histological staging is a reliable method for
Smith R, et al., Ann R Coll Surg Engl, 2009 Feb 13 (Epub ahead of print).
predicting recurrence. However, it should be used in association This article primarily reviews corrective surgery for Dupuytren’s
with clinical data to determine precisely the prognosis of patients disease as it represents a significant proportion of a hand
suffering from Dupuytren’s contracture. ■ surgeon’s workload. The article discusses the decision to go ahead
with surgery, the success of surgery and how it requires
Does a ‘Firebreak’ Full-thickness Skin Graft Prevent measuring the degree of contracture of the diseased finger(s). The
Recurrence After Surgery for Dupuytren's Contracture?: article discusses a study in which 60 patients with Dupuytren’s
A Prospective, Randomised Trial disease are being monitored in terms of the recurrence of the
Ullah AS, et al., J Bone Joint Surg Br, 2009;91:374–8.
contracture, and how it can inform surgical outcome, research and
The article discusses a study involving 79 patients with audit. The study concludes that visual estimations of Dupuytren’s
Dupuytren’s contracture of the proximal interphalangeal joint to contractures correlate well with actual clinical goniometric
have either a ‘firebreak’ skin graft or a fasciectomy and if, after full measurements and improve further if measured with computer
correction, the skin over the proximal phalanx could be easily software. Digital images permit monitoring of contracture after
closed by a Z-plasty. The degree of contracture of the surgery and may facilitate research into disease progression and
metacarpophalangeal and interphalangeal joints of the operated auditing of surgical technique. ■
18 EUROPEAN DERMATOLOGY
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