Musters, F.M. (2017) The Influence of the Extensiveness of Surgery for Dupuytren's Disease on the functional Outcome and Convalescence. thesis, Medicine.
Full text available on request.Abstract
Introduction Dupuytren Disease is a common disorder for which the Limited Fasciectomy is the most commonly used procedure, even though it will often lead to complications and has a relatively long rehabilitation period. It is, however, unknown if it is better to limit such a surgical procedure to the bare minimum, or to perform a more extensive procedure. The aim of this study was to evaluate the difference in functional outcome of a Limited Fasciectomy if a patient is operated on a higher (over-operating), lower (under-operating), or equal number of rays compared to the number of rays with an indication for surgery (rays with a pre-operative total passive extension deficit (TPED) of >30°). The total active flexion deficit (TAFD) was used as the primary outcome measure for functional outcome and the total active extension deficit (TAED) as a secondary outcome measure. Method The study was a retrospective medical file study of patients treated for Dupuytren Disease by Limited Fasciectomy from 2012 to 2016 at the UMC Groningen. A group of 144 patients was included in the six weeks postoperative analysis and a group of 105 patients in the three months postoperative analysis. Normative values for the active range of motion of the American Medical Association were used as a reference. The rays with the highest deficits (TAFD and TAED) were used in each of the analyses. Multiple linear regression models were used to correct for possible confounders. Results Under- and over-operating showed no significant decrease or increase of TAFD at six weeks or at three months postoperatively. Under-operating had no significant effect on the TAED. Over-operating led to a significant decrease in TAED at three months (p=0.013). Factors that significantly raised the TAFD at six weeks were diabetes (p=0.036) and the presence of complications (p=0.009). At three months, an increased number of operated rays increased the TAFD (p=0.014). Factors that raised the TAED were: An increase in the number of operated rays (p=0.014 at six weeks and p=0.039 at three months) and an increase in the preoperative TPED (p=0.014 at six weeks and p=0.017 at three months). Conclusion Under-operating showed no significant increase or decrease in functional outcome compared to a procedure with an equal number of affected and operated rays. Over-operating, however, showed a decrease in TAED, but a substantiated explanation for this cannot be provided by this study. Further research is required.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Werker, prof. dr. P.M.N. and University Medical Center Groningen and Department of Plastic Surgery |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:39 |
| Last Modified: | 25 Jun 2020 10:39 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/81 |
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