title: Recurrence after Surgery for Dupuytren’s Disease: A Randomized Trial of Two Skin Incisions Skin Tension in the Aetiology of Dupuytren’s Disease; a Prospective Trial A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study. The Surgical Treatment of Dupuytren’s Contracture: A Synthesis of Techniques
abstract: We studied the influence of the type of skin incision on the recurrence rate  following fasciectomy for Dupuytren ’s disease . Patients were r and omized to a longitudinal incision closed with Z-plasties or a modified Bruner incision closed by Y – V plasties .  Follow-up was for at least 2 years or until a recurrence was noted . We found no statistical difference in recurrence rate between patients having these two skin incisions and closures Tension in the palmar fascia has been proposed as a factor causing Dupuytren ’s disease . If tension does stimulate the growth of new Dupuytren ’s tissue , relieving longitudinal tension should reduce the recurrence rate following surgery . Thirty patients with palmar Dupuytren ’s contracture of a single ray that affected only the metacarpophalangeal joint were divided into two groups . Both groups had a fasciotomy : one group through a transverse incision that was closed directly and the other through a longitudinal incision with Z-plasty closure . Half the patients ( seven of 14 ) who had direct closure had recurrence at 2 years as compared to two of the 13 in the Z-plasty group . The trial was stopped at the interim analysis stage due to the high recurrence rate in the first group . These results are consistent with the tension hypothesis for the aetiology of Dupuytren ’s disease PURPOSE The dem and for percutaneous needle fasciotomy ( PNF ) as treatment for Dupuytren 's disease is increasing because of its limited invasiveness , good outcome , limited number of complications , quick recovery , and overall patient satisfaction . This r and omized controlled trial was design ed to test whether these short-term expectations are sound by comparing this treatment with limited fasciectomy ( LF ) with regard to these aspects . METHODS We treated 166 rays : 88 by PNF and 78 by LF .  Total passive extension deficit ( TPED ) improvement at 1 week and at 6 weeks were the primary outcome parameters ; patient satisfaction , h and -function recovery , and complication rate were secondary outcome parameters . We used the Disabilities of the Arm , Shoulder , and H and question naire to measure disabilities of the upper extremity before and after treatment and all adverse effects and complications were recorded . RESULTS Overall TPED improvement was best at 6 weeks . In the PNF group TPED improved by 63 % versus 79 % in the LF group ; this difference was statistically significant . Results at the proximal interphalangeal joint were worse than those at the metacarpophalangeal and distal interphalangeal joints for both the PNF and LF groups . The rays classified before surgery as Tubiana stages I and II showed no difference between these treatments , but for rays higher than stage II LF clearly was superior to PNF as a treatment modality . The rate of major complications in the LF group was 5 % versus 0 % in the PNF group . Patient satisfaction was almost equal but direct h and function after treatment was considered better in the PNF group , as was the degree of discomfort that patients experienced . This was underscored by the Disabilities of the Arm , Shoulder , and H and scores in the PNF group , which were significantly lower than those in the LF group at all time points measured . CONCLUSIONS In the short term and in cases with a TPED of 90 degrees or less PNF is a good treatment alternative to LF for treatment of Dupuytren 's disease . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic , Level Dupuytren ’s disease is an affliction of the palmar fascia . Selective fasciectomy is recommended once contracture has occurred . Alternatives for wound closure include tissue rearrangement , the open palm technique , and full-thickness skin grafting . In this prospect i ve study , a new “ synthesis ” technique was used to treat a cohort of patients with advanced Dupuytren ’s disease . The results were then compared with those of a second cohort of patients who underwent the open palm technique . Thirty consecutive patients were selected . Ten patients ( nine men and one woman ; average age , 67 years ) underwent the open palm technique , and 20 patients ( 18 men and two women ; average age , 70 years ) underwent the synthesis method .  Follow-up was 3.5 years for the open palm group and 2.7 years for the synthesis group . All patients in both groups improved with respect to motion , function , appearance , and satisfaction . Objective ly , for the open palm technique , metacarpophalangeal joint contracture decreased from 50 degrees to 0 degrees , and proximal interphalangeal joint contracture decreased from 40 degrees to 6 degrees . Using the synthesis method , metacarpophalangeal joint contracture decreased from 57 degrees to 0 degrees , and proximal interphalangeal joint contracture decreased from 58 degrees to 10 degrees . The Disabilities of the Arm , Shoulder , and H and Test scores decreased from 37 to 30 in both groups . There were no significant differences between groups in these parameters . The two significant intergroup differences were healing time ( 40 days for the open palm technique versus 28 days for the synthesis method ) and recurrence rate ( 50 percent for open palm versus 0 percent for synthesis ) . The synthesis technique combines with success the best features of current methods for the surgical treatment of advanced Dupuytren ’s disease
target: There are only three Level I studies comparing surgical techniques for the treatment of primary Dupuytren ’s contracture , and the evidence does not support one procedure above another , other than to show a particularly high recurrence rate after needle fasciotomy .
background: There is no consensus on the most effective operation for primary Dupuytren ’s contracture .
  This systematic review evaluates the reported rates of recurrence and complications , as well as the strength of evidence , for individual procedures .