Percutaneous Aponeurotomy and Lipofilling versus Limited Fasciectomy for Dupuytren's Contracture: 5-Year Results from a Randomized Clinical Trial
Plastic and Reconstructive Surgery , Volume 142 - Issue 6 p. 1523- 1531
BACKGROUND: In the Dupuytren Rotterdam randomized controlled trial, percutaneous aponeurotomy with lipofilling (PALF) was as effective as limited fasciectomy in correcting primary Dupuytren's contracture after 1 year. The authors report the 5-year results of this trial, with a special focus on recurrence of contractures. METHODS: The authors invited all patients who had undergone PALF or limited fasciectomy to participate in a posttrial follow-up assessment. Thirty-one PALF patients and 21 limited fasciectomy patients were assessed by an independent examiner for the degree of contracture and whether patients had undergone a secondary procedure. The primary composite endpoint was recurrence rate, defined as either 20 degrees or greater worsening in contracture (relative to week 3) or as having undergone a secondary procedure for a new or worsening contracture. RESULTS: At 5 years, more joints in the PALF group than in the limited fasciectomy group had a recurrence (74 percent versus 39 percent; p = 0.002). When redefining recurrence as a worsening in total extension deficit of at least 30 degrees for treated digits as often reported, this was 77 percent versus 32 percent (p = 0.001). Total extension deficit was also worse for PALF-reated digits (53 degrees versus 31 degrees; p < 0.010). CONCLUSIONS: Although the authors previously reported that PALF offers a shorter convalescence and fewer long-term complications but a similar degree of contracture correction at 1-year follow-up, at 5 years, the corrections were less durable than those for limited fasciectomy. This again highlights that limited fasciectomy and different types of needle aponeurotomy have specific advantages and disadvantages to weigh by patients and clinicians. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.