Partielle Fasziektomie und lappenplastische Deckungsoptionen beim Morbus Dupuytren

 

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Zusammenfassung

Zielsetzung: Durchführung einer partiellen Fasziektomie bei Morbus Dupuytren Grad III–IV der Hand und Defektdeckung mittels lokaler Lappenplastiken.

Indikation: Der Morbus Dupuytren ist eine progredient verlaufende Erkrankung der Hände. Hierbei kommt es zur Ausbildung von Fasziensträngen, welche eine Beuge- sowie Adduktionskontraktur der Finger bis hin zur vollständigen Unbrauchbarkeit der Hand nach sich ziehen können.

Methode: Die partielle Fasziektomie ist bei mehrfingrigem Befall der Goldstandard in der Behandlung des Morbus Dupuytren. Nach Resektion der die Kontraktion bedingenden Fasern und ggf. notwendigen Arthrolysen können die Finger im Idealfall die Neutralposition wieder erreichen. Die sich aufgrund der wiederhergestellten Streckmöglichkeit ergebenden Hautdefekte müssen durch Z-Plastiken, lokale oder Fernlappen der Hand gedeckt werden.

Schlussfolgerung: Insbesondere bei fortgeschrittenem Grad der Dupuytren-Kontraktur resultieren große Weichteildefekte. Die mikrochirurgische Präparation von Nerven und Gefäßen gestaltet sich aufgrund der sie ummauernden Faszienstränge häufig als schwierig. Eine exakte präoperative Planung von Resektionsausmaß und Rekonstruktionsoptionen sind essenziell und bestimmen die Schnittführung maßgeblich.

Abstract

Aim: Partial fasciectomy in cases of grade III–IV Dupuytrenʼs contracture and coverage of the defect with local flaps.

Indication: Dupuytrenʼs contracture is a progressive disease of the hand associated with the formation of fascial cords, which may result in flexion and adduction contractures of the fingers leading up to complete dysfunction of the hands.

Method: If several fingers are affected, partial fasciectomy is the gold standard in the treatment of Dupuytrenʼs contracture. Ideally, the fingers reach the neutral position after the fibres causing the contracture are resected and arthrolysis is performed as needed. The skin deficits resulting from restored extension have to be covered by the use of Z-plasties, local or pedicled flaps of the hand.

Conclusion: The resection of contracting cords in advanced cases of Dupuytrenʼs contracture leads to large soft tissue defects. The microsurgical preparation of nerve and vascular structures is often difficult because of the fascial cords surrounding them. Exact preoperative planning of the extent of resection, as well as reconstruction options are essential and determine how incisions are made. To prevent a relapse, it is essential to reverse skin fibre direction using flaps and to insert intact skin with preserved subdermal adipose tissue.

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