Many techniques have been described to cover the skin defect created by perioperative extension of the joints after fasciectomy in Dupuytren's finger contracture.
In severe stages of Dupuytren's contractures, we have been using a combination of three flaps, designed to allow a full primary closure of the skin incisions, even in grades III or IV of this disease. This strategy includes a palmar advancement flap (similar to the so-called “Hueston's flap”). A rotational lateral triangular flap (similar to those designed by Colson and Razemon) and an opposite distally based palmar triangular flap (similar to those described by Harrison and Pelissier). Results obtained with this combination spurred us on to undertake a retrospective study to look at the efficiency of this strategy. We looked for local complications, scar quality, pre- and postoperative extension scores.
Among the 10 patients we reviewed, ten combinations of three flaps were performed (mostly 3rd and 4th fingers). Four patients had preoperative stage IV, three stage III and three stage II contracture. No one needed volar skin graft. No local complication occurred, especially no flap necrosis (partial or total). Average patient and Observer Scar Assessment Scale score was 29.2 over 120 [13–56], which can be considered satisfying, 12 being the score for normal skin and 120 for the worst scar imaginable. At the time of the revision, finger extension was complete for three patients, six had stage I and one stage II lack of extension. Mean revision time was 9.5 months [1–23].
In our experience, the three flaps technique permits to achieve primary closure even in severe cases of contracture, when perioperative extension of the finger leads to an extensive skin defect. It gives satisfying clinical results with low morbidity and permits to avoid volar skin graft. Although a longer follow-up should be required to fully establish the efficiency of this technique, early results are promising. Careful and precise planification of the three flaps is required to get full advantage from this technique.
The three flaps technique is a simple and reliable method for volar skin closure after fasciectomy in Dupuytren's disease when skin defect is important.
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Publié par Elsevier Masson SAS.