There are three mechanical approaches for Dupuytren’s. In order of both increasing problems and long term effectiveness, these are: fasciotomy (cut fascia); fasciectomy (remove fascia); dermofasciectomy (remove both skin and fascia). The popularity of dermofasciectomy and skin grafting has been limited by concerns regarding complications of wound healing and loss of flexion. Some of these concerns stem from the historical use of dermofasciectomy as a revision procedure after failed fasciectomy, a group biased toward poor results. Dermofasciectomy as the primary or first operation is a different story. This study reviews technical tips for dermofasciectomy and shows that for patients with diffuse skin involvement, primary dermofasciectomy and skin grafting has a better chance of long term control than fasciectomy. http://www.dupuytrenfoundation.org/DupPDFs/2000_Armstrong_1046.pdf
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