A new finger-preserving procedure as an alternative to amputation in recurrent severe Dupuytren contracture of the small finger | BMC Musculoskeletal Disorders

In patients with Dupuytren disease (DD) recurrent contracture of the proximal interphalangeal (PIP) joint of the small finger is a difficult problem. The severely contracted finger impedes activities of daily living and work. Various treatments have been proposed including traction by external fixator followed by surgery [1, 2], staged surgery [3], amputation with ray resection [4], and reconstruction using local skin flaps [5, 6]. Other more complex procedures involve complete skin and fascial excision and resurfacing with regional tissue transfer such as forearm-based flap and possible free flap (adipofascial radial forearm flap or free temporoparietal fascia flap). However, results in terms of residual symptoms, hand function and cosmetic appearance have generally been unsatisfactory.

When all surgical and other treatments have failed the only remaining option to offer patients has often been amputation of the affected finger. It has been estimated that finger amputations constitute approximately 2% of all surgical procedures performed on patients with DD [7, 8]. The small finger is the most common finger on which amputation is performed. Amputation is associated with risks such as phantom pain and cold intolerance that, if severe, may substantially affect patient’s quality of life [9,10,11,12]. In addition, the cosmetic result of finger amputation is troublesome for some patients.

As an alternative to finger amputation we have devised a novel surgical procedure that involves total excision of the middle phalanx and creation of a functioning single interphalangeal joint. To our knowledge, this procedure has not been described previously although the underlying concept, removal of the middle phalanx, has been reported in 2 previous publications. Honecker et al. described a procedure in which the middle phalanx of the small finger is removed followed by fusion of the proximal and distal phalanx in 7 patients with DD or posttraumatic PIP joint contracture [13]. Teboul et al. has described a procedure, done on a patient with recurrent Dupuytren contracture of the small finger after two previous subtotal fasciectomy procedures, involving simple removal of the middle phalanx but without the ligament reconstruction necessary to create a functioning interphalangeal joint [14].

We have performed this novel finger-preserving procedure of total excision of the middle phalanx and creation of a functioning single interphalangeal joint on two patients with recurrent severe Dupuytren contracture of the small finger.