Dupuytren’s Hand Surgery Consultant掌腱膜手外科顾问.pptxVIP

Dupuytren’s Disease Mr G Shyamalan (Shyam) Hand Surgeon HEFT So Much Choice! Benign proliferative disease Fascia of digits and palm Nodules, cords and contractures Definition of Dupuytren’s Need yes to one of the questions to approve Moderate MCPJ contracture 30 degrees Any PIPJ contracture First web contracture Procedures of Limited Clinical Effectiveness (POLCE) Age Ancestry Sex FH Diabetes Smoking and Alcohol Epilepsy Risk Factors Dupuytren’s Nodules 50% progress10% require surgery Trauma Surgery Diabetes No FH Any race Generally non-progressive Non-Dupuytren’s Disease Male 50 Affected siblings/parents Ectopic Disease ‘Garrod’s pads’ Bilateral Disease Dupuytren’s Diathesis 1. Do nothing 2. Radiotherapy – early disease 3. Steroid Injection 4. Percutaneous Needle Fasciotomy 5. Collagenase/Xiapex 6. Limited Fasciectomy 7. Dermato-fasciectomy and skin graft 8. Amputation Treatment options 1. Do nothing ￡0 2. Radiotherapy – early disease ￡2500 (10 visits) 3. Steroid Injection (￡ Steroid vial +OPD) 4. Percutaneous Needle Fasciotomy (￡ OPD +needle +/- theatres) 5. Collagenase/Xiapex (￡760 per vial/digit) 6. Limited Fasciectomy (￡2500 plus therapy) 7. Dermato-fasciectomy and skin graft (￡3000 plus therapy) Treatment options cost(2011) 1. Age/Retirement 2. Occupation 3. Hand Dominance 4. Pain 5. The speed of progression of disease 6. Recurrence Vs Extension 7. Extent of contracture PIP joint 8. Diathesis (bilateral, radial side, male) 9. General Systemic Health 10.Patient expectations Personal thought process Radiotherapy 3 Gy x5 days- repeat 8 weeks later (potential delayed side effects due to radiation) Triamcinalone 50% softening 50% recurrence one year Steroid for nodules Mostly clinic based Splint 6 – 12 weeks at night Low complication rate Early return to work 5% early failure – akin to a failed injection for CMC joint arthritis! Long-term 50% recurrence in 5 years but not always requiring surgery Percutaneous Needle Fasciotomy Good option for e