Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence

The aim of this study was to determine a definition of recurrence of Dupuytren disease that could be utilized for the comparison of the results independently from the treatment used. 24 hand surgeons from 17 countries met in an international consensus conference. The participants used the Delphi method to evaluate a series of statements: (1) the need for defining recurrence, (2) the concept of recurrence applied to the Tubiana staging system, (3) the concept of recurrence applied to each single treated joint, and (4) the concept of recurrence applied to the finger ray. For each item, the possible answer was given on a scale of 1-5: 1=maximum disagreement; 2=disagreement; 3=agreement; 4=strong agreement; 5=absolute agreement. There was consensus on disagreement if 1 and 2 comprised at least 66% of the recorded answers and consensus on agreement if 3, 4 and 5 comprised at least 66% of the recorded answers. If a threshold of 66% was not reached, the related statement was considered not defined. A need for a definition of recurrence was established. The presence of nodules or cords without finger contracture was not considered an indication of recurrence. The Tubiana staging system was considered inappropriate for reporting recurrence. Recurrence was best determined by the measurement of a specific joint, rather than a total ray. Time 0 occurred between 6 weeks and 3 months. Recurrence was defined as a PED of more than 20\ub0 for at least one of treated joint, in the presence of a palpable cord, compared to the result obtained at time 0. This study determined the need for a standard definition of recurrence and reached consensus on that definition, which we should become the standard for the reporting of recurrence. If utilized in subsequent publications, this will allow surgeons to compare different techniques and make is easier to help patients make an informed choice.usammenfassung Ziel der Konsensuskonferenz in Rom war es, eine Definition des Rezidivs bei Morbus Dupuytren festzulegen, die fur einen Vergleich der Ergebnisse unabhangig von der gewahlten Behandlung einsetzbar ist. 24 Handchirurgen aus 17 Landern kamen im Rahmen einer internationalen Konsensuskonferenz zusammen. Die Teilnehmer wendeten die Delphi-Methode an, um folgende Thesen zu bewerten: (1) die Notwendigkeit einer Definition des Rezidivs bei Morbus Dupuytren, das Rezidiv soll (2) auf die Stadieneinteilung nach Tubiana, (3) fur jedes einzelne behandelte Gelenk, oder (4) auf den Fingerstrahl angewandt werden. Jede These konnte auf einer Skala von 1 bis 5 bewertet werden: 1=stimme gar nicht zu; 2=stimme nicht zu; 3=stimme zu; 4=stimme sehr zu; 5=stimme vollstandig zu. Keine Zustimmung lag vor, wenn mindestens 66% der erfassten Antworten auf 1 und 2 entfielen und Zustimmung lag vor, falls mindestens 66 % der erfassten Antworten auf 3, 4 und 5 entfielen. Falls der Schwellenwert von 66% nicht erreicht wurde, wurde die jeweilige Aussage als "nicht definiert betrachtet. Die Notwendigkeit einer Definition des Rezidivs bei Morbus Dupuytren wurde mit dieser Methode festgestellt. Das Vorliegen von Knoten oder Sehnen ohne Kontraktur der Finger wurde nicht als Anzeichen eines Rezidivs gewertet. Die Stadieneinteilung nach Tubiana stellte sich als ungeeignet zur Beschreibung eines Rezidivs heraus. Ein Rezidiv bei Morbus Dupuytren ist besser durch die Messung eines spezifischen Gelenks als durch eine Messung der Beugekontraktur des gesamten Fingerstrahls bestimmt. Der Ausgangspunkt Null wurde definiert als Zeitraum zwischen 6 Wochen und 3 Monaten nach der primaren Behandlung. Ein Rezidiv wird dann definiert als eine passive Beugekontraktur von mehr als 20 degrees fur jedes behandelte Gelenk bei Vorliegen eines tastbaren Stranges, verglichen mit dem Ergebnis zum Zeitpunkt Null. Die Konferenz zeigte die Notwendigkeit einer Definition des Rezidivs bei Morbus Dupuytren und fuhrte zu einem Konsens in Bezug auf diese Definition. Bei Verwendung in nachfolgenden Publikationen wird sie es ermoglichen, verschiedene Techniken zu vergleichen und die Patienten beim Treffen einer informierten Entscheidung zu unterstutzen

Recurrence of Dupuytren’s contracture: A consensus-based definition

Purpose: One of the major determinants of Dupyutren disease (DD) treatment efficacy is recurrence of the contracture. Unfortunately, lack of agreement in the literature on what constitutes recurrence makes it nearly impossible to compare the multiple treatments alternatives available today. The aim of this study is to bring an unbiased pool of experts to agree upon what would be considered a recurrence of DD after treatment; and from that consensus establish a much-needed definition for DD recurrence. Methods: To reach an expert consensus on the definition of recurrence we used the Delphi method and invited 43 Dupuytren’s research and treatment experts from 10 countries to participate by answering a series of questionnaire rounds. After each round the answers were analyzed and the experts received a feedback report with another questionnaire round to further hone in of the definition. We defined consensus when at least 70% of the experts agreed on a topic. Results: Twenty-one experts agreed to participate in this study. After four consensus rounds, we agreed that DD recurrence should be defined as “more than 20 degrees of contracture recurrence in any treated joint at one year post-treatment compared to six weeks post-treatment”. In addition, “recurrence should be reported individually for every treated joint” and afterwards measurements should be repeated and reported yearly. Conclusion: This study provides the most comprehensive to date definition of what should be considered recurrence of DD. These standardized criteria should allow us to better evaluate the many treatment alternatives

Recent Surgical and Medical Advances in the Treatment of Dupuytren’s Disease - A Systematic Review of the Literature

Dupuytren’s disease (DD) is a type of fibromatosis which progressively results in the shortening and thickening of the fibrous tissue of the palmar fascia. This condition which predominantly affects white-northern Europeans has been identified since 1614. DD can affect certain activities of daily living such as face washing, combing hair and putting hand in a glove. The origin of Dupuytren’s contracture is still unknown, but there are a number of treatments that doctors have come across throughout the years. Historically surgery has been the mainstay treatment for DD but not the only one. The objective is to make a structured review of the most recent advances in treatment of DD including the surgical and medical interventions. We have looked at the most relevant published articles regarding the various treatment options for DD. This review has taken 55 articles into consideration which have met the inclusion criteria. The most recent treatments used are multi-needle aponeurotomy, extensive percutaneous aponeurotomy and lipografting, injecting collagenase Clostridium histolyticum, INF-gamma and shockwave therapy as well as radiotherapy. Each of these treatments has certain advantages and drawbacks and cannot be used for every patient. In order to prevent this condition, spending more time and money in the topic is required to reach better and more consistent treatments and ultimately to eradicate this disease

Skin involvement in Dupuytren's disease.

Whether the palmar skin has a role in the development, propagation or recurrence of Dupuytren's disease remains unclear. Clinical assessment for skin involvement is difficult and its correlation with histology uncertain. We prospectively biopsied the palmar skin of consecutive patients undergoing single digit fasciectomy (for primary Dupuytren's disease without clinically involved skin) and dermofasciectomy (for clinically involved skin or recurrence) in order to investigate this relationship. We found dermal fibromatosis in 22 of 44 patients (50%) undergoing fasciectomy and 41 of 59 patients (70%) undergoing dermofasciectomy. Dermal fibromatosis appeared to be associated with greater preoperative angular deformity, presence of palmar nodules and occupations involving manual labour. Dermal fibromatosis exists in the absence of clinical features of skin involvement and we hypothesize that the skin may have a greater role in the development and propagation of Dupuytren's disease than previously thought.III