Dupuytren’s disease: using keystone techniques to improve vascular dynamics in fasciectomy
Main Article Content
Keywords
complications, Dupuytren’s disease, fasciectomy, keystone perforator islander flaps, hypervascularity
Abstract
Background: Palmar defects arising from surgical correction for Dupuytren’s disease can be surgically corrected using skin grafts. This article describes the applications of keystone principles as an alternative to John Hueston’s firebreak graft, popularised in the mid-1980s.
Method: In 2003, I introduced the principle of a fenestrated, full-thickness graft to optimise graft-take and expedite healing, offering an alternative for the management of palmar defects created by surgical release.
Results: The combination of reliable hypervascularity with a pain-free postoperative phase, characteristic of KPIF, ensures an easy recovery with early commencement of hand therapy. With minimal vascular complications (apart from clinical cases where diabetes and smoking are factors) the overall surgical outcome gives an aesthetic appearance matching surrounding tissues.
Conclusion: Island flaps based on the keystone principle improve vascularity resulting in minimal complications with healing. Recurrence of Dupuytren’s disease following this technique has not been observed to date.
Article Metrics Graph
References
2. Behan FC, Findlay MW and Lo CH. The keystone perforator island flap concept. Chatswood, Sydney: Elsevier Australia, 2012.
3. Gosset J. Treatment of Dupuytren's disease by MacIndoe's technique. Mem Acad Chir (Paris). 1951 Mar 14-Apr 4; 77(10-11):312-8.
4. McCash CR. The open palm technique in Dupuytren's contracture. Br J Plast Surg. 1964, 17:271-280. https://doi.org/10.1016/S0007-1226(64)80043-6
5. Hueston JT. The control of recurrent Dupuytren's contracture by skin replacement. Br J Plast Surg. 1969; 22(2):152-56. https://doi.org/10.1016/S0007-1226(69)80057-3
6. McGregor IA. The z-plasty in hand surgery. J Bone Joint Surg Br. 1967;49(3):448-57. https://doi.org/10.1302/0301-620X.49B3.448 PMid:5341268
7. Gillies H and Millard DR. The principles and art of plastic surgery. London: Butterworth and Co. 1957.
8. Behan FC, Rozen WM, Kapila S, Ng SK. Two for the price of one: a keystone design equals two conjoined flaps. ANZ J Surg. 2011 June;81(6):405-06. https://doi.org/10.1111/j.1445-2197.2011.05772.x PMid:22022822
9. Anthony SG, Lozano-Calderon SA, Simmons BP, Jupiter JB. Gender ratio of Dupuytren's disease in the modern US population. Hand. 2008 June;3(2):87-90. https://doi.org/10.1007/s11552-007-9076-9 PMid:18780082 PMCid:PMC2529131
10. Rodrigues JN, Becker GW, Ball C Zhang W, Giele H, Hobby J, Pratt AL, Davis T. Surgery for Dupuytren's disease of the fingers. Cochrane Database Syst Rev. 2015 Dec 9;(12):CD010143. PMid:26648251
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open access journal: all articles will be immediately and permanently free for everyone to read and download. Authors will retain copyright of their article and have a choice of publishing under the following Creative Commons Licence terms:
Creative Commons Attribution (CC BY)
Lets others distribute and copy the article, create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), include in a collective work (such as an anthology), text or data mine the article, even for commercial purposes, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honour or reputation.