Friday, March 27, 2015

Options for severe recontracture: recurrent Dupuytren contracture

The worst and unsolved part of Dupuytren contracture is recontracture after treatment, and then recontracture after retreatment. Most people don't have this problem, but when they do, the most common joint to have this problem is the small (pinky) finger PIP joint - the joint in the middle of the finger.

Recontracture after a minimally invasive treatment is often treated with fasciectomy (the most common open surgery), but what are the options when there is severe recontracture after fasciectomy? There are 3 traditional options recommended by hand surgeons.
1. Dermofasciectomy. This operation involves removing Dupuytren tissue and old scar tissue and replacing the skin of the front (palm) half of the finger with skin graft. It has the best chance of long term control, but has 3 potential problems:
  • The complication rate is higher than for fasciectomy, but this is actually because the complication rate goes up with every redo surgery, and dermofasciectomy is often done as the second or third operation. The fewer operations before dermofasciectomy, the better.
  • The previously operated finger may have so much scarring of the blood vessels that when the surgeon releases everything and tries to straighten the finger, it may start to cut off the circulation. If that happens, it limits how much improvement the surgery can give.
  • PIP joint (the knuckle you use to knock on a door) contractures greater than 60 degrees tend to stretch out the tendons on the back of the knuckle which straighten the joint and at the same time shrink the ligaments on the front side of the joint. These issues are hard to perfectly correct even with surgery: the finger may be brought back to a straight position in the operating room, but relapse over the weeks that follow into a stiff bend, despite everything the surgeon, patient and therapist can do. Frustrating.
2. PIP joint fusion. Fusion (or arthrodesis) is removing the joint and making the two bones grow together to form one bone. It's usually done through a cut on the back of the finger, avoiding the battleground of the previous surgery to reduce the risk of nerve and circulatory injuries. The advantage is that the joint will not contract again. The disadvantage is that the joint won't bend again. Normally, the PIP joint is fused in a partial bend - as bent as it can be without catching on things, which really depends on how bent the next joint back is - the MCP joint (the knuckle you use to punch something). There are 3 issues with this operation:
  • There's no perfect angle for a fused PIP - you have to choose between not catching it on things or not making a fist. Some people see fusing the joint bent as not much better than what they already have.
  • It shortens the finger quite a bit, because the flesh on the palm side of the finger won't stretch out. It doesn't bring the finger back out to its original length.
  • It makes a strange grip, because the joint doesn't bend where it used to.
Amputation. Only a consideration if requested by the patient because they have just had it with the finger and want to move on. If you're not at this point, amputation isn't for you. 

I'll review two newer procedures in the next post. 

20 comments:

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  11. Thanks to this great herbal doctor who cured my friend of HIV/aids, his name is Dr. Iyabiye. My friend suffered HIV for so long that she lost her job and became stranded financially because of HIV antiretroviral drugs she buys every time. Until 2 months ago when I heard about this doctor and I did contacted him to help my friend, he administered his medication on her and she was confirmed cured and free at the hospital after the treatment. I came here to inform the general public and to safe people from this life threatening & killing disease. Contact: iyabiyehealinghome@gmail.com (+2348072229413 / +2348158577300)

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  12. Here is a great herbal doctor who cured me of Hepatitis B. his name is Dr. Imoloa. I suffered Hepatitis B for 11 years, I was very weak with pains all over my body my stomach was swollen and I could hardly eat. And one day my brother came with a herbal medicine from doctor Imoloa and asked me to drink and I drank hence there was no hope, and behold after 2 week of taking the medicine, I started feeling relief, my swollen stomach started shrinking down and the pains was gone. I became normal after the completion of the medication, I went to the hospital and I was tested negative which means I’m cured. He can also cure the following diseases with his herbal medicine...lupus, hay fever, measles, dry cough, diabetics hepatitis A.B.C, mouth ulcer, mouth cancer, bile salt disease, fol ate deficinecy, diarrhoea, liver/kidney inflammatory, eye cancer, skin cancer disease, malaria, chronic kidney disease, high blood pressure, food poisoning, parkinson disease, bowel cancer, bone cancer, brain tumours, asthma, arthritis, epilepsy, cystic fibrosis, lyme disease, muscle aches, cholera, fatigue, muscle aches, shortness of breath, alzhemer's disease, acute myeloid leukaemia, acute pancreatitis, chronic inflammatory joint disease, inflammatory bowel disease, Addison's disease back acne, breast cancer, allergic bronchitis, Celia disease, bulimia, congenital heart disease, cirrhosis, fetal alcohol spectrum, constipation, fungal nail infection, fabromyalgia, (love spell) and many more. he is a great herbalist man. Contact him on email; drimolaherbalmademedicine@gmail.com. You can also reach him on whatssap- +2347081986098.

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  13. Suffering from herpes virus is a terrible experience because i was told it has no cure,the good news am happily sharing now is the great power behind herbal medication i got diagnosed of herpes virus in the year  2016 and in 2018 i started having outbreaks and it became more terrible for me to bare,One blissful morning i came across a blog comment posted by a man call Thompson on how he was cured of herpes simplex virus type 2 with the herbal medication of Dr Ehimare)who is a specialist in curing all kinds of std virus and chronic disease with herbs,i immediately copied out his contact mail that was drehimarespelltemple@gmail.com Or Via WhatsApp  +2348077694025 and i explain all my problems to him, he was very honest with me and also kept his promise to get me cured with his herbs if i follow the prescriptions he gives along with the medication which i did exactly as he prescribed, to God be the glory My herpes simplex virus i have been suffering from got cured in just 2 weeks after completing the dose of his herbal cure. once again thank you so much sir for restoring my health back and most especially my skin. Please for any who has health problem of any kind should mail him on the email provided above mail me directly... Give him a chance and see what he can do.

    ReplyDelete
  14. I have been suffering from (HERPES) disease for the last four years and had constant pain, especially in my knees. During the first year, I had faith in God that I would be healed someday.This disease started to circulate all over my body and I have been taking treatment from my doctor, a few weeks ago I came on search on the internet if I could get any information concerning the prevention of this disease, on my search I saw a testimony of someone who has been healed from (Hepatitis B and Cancer) by this Man Dr. Silver and she also gave the email address of this man and advise we should contact him for any sickness that he would be of help, so I wrote to Dr. Silver telling him about my (HERPES Virus) he told me not to worry that I was going to be cured!! hmm i never believed it,, well after all the procedures and remedy given to me by this man few weeks later I started experiencing changes all over me as the Dr. assured me that I have cured, after some time i went to my doctor to confirmed if I have been finally healed behold it was TRUE, So friends my advice is if you have such sickness or any other at all you can email Dr. Silver (drsilverhealingtemple@gmail.com) sir I am indeed grateful for the help I will forever recommend you to my friends!!! with your lovely Email Address ( drsilverhealingtemple@gmail.com

    ReplyDelete
  15. There is a safe & effective Natural Herbal Medicine. For Total Cure Call    +2349010754824,  or email him   drrealakhigbe@gmail.com       For an Appointment with (Dr.) AKHIGBE contact him. Treatment with Natural Herbal Cure. For:Dengue Fever, Malaria. Painful or Irregular Menstruation. HIV/Aids. Diabetics. Vaginal Infections. Vaginal Discharge. Itching Of the Private Part. Breast Infection. Discharge from Breast. Breast Pain & Itching. Lower Abdominal Pain. No Periods or Periods Suddenly Stop. Women Sexual Problems. High Blood Pressure Chronic Disease. Pain during Sex inside the Pelvis. Pain during Urination. Pelvic Inflammatory Disease, (PID). Dripping Of Sperm from the Vagina As Well As for Low sperm count. Parkinson disease. Obesity, Lupus.  Cancer.  Tuberculosis.  Zero sperm count. Bacteria Diarrhea.Herpatitis A&B, Rabies. Asthma.  Quick Ejaculation. Gallstone,  Premature Ejaculation. Herpes. Joint Pain. Stroke. Weak Erection.  Erysipelas, Thyroid, Discharge from Penis. HPV.  Hepatitis A and B. STD. Staphylococcus + Gonorrhea + Syphilis. Heart Disease.  Pile-Hemorrhoid.rheumatism, thyroid, Autism, Penis enlargement,  Waist & Back Pain.  Male Infertility and Female Infertility. Etc. Take Action Now. contact him & Order for your Natural Herbal Medicine:  +2349010754824  and email him    drrealakhigbe@gmail.com    Note For an Appointment with (Dr.) AKHIGBE.I suffered in Cancer for a year and three months dieing in pain and full of heart break. One day I was searching through the internet and I came across a testimony herpes cure by doctor Akhigbe. So I contact him to try my luck, we talk and he send me the medicine through courier service and with instructions on how to be drinking it.To my greatest surprise drinking the herbal medicine within three weeks I got the changes and I was cure totally. I don't really know how it happen but there is power in Dr Akhigbe herbal medicine. He is a good herbalist doctor.

    ReplyDelete
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  17. FINALLY FREE FROM HERPES VIRUS.
    what a miracle i never believe there is cure because my doctor tested me herpes positive and she told me there is no cure, i’m very happy today that i’m having a free life without this herpes virus, i can remember some months ago when i was crying all through the night and day that i can’t get cured from this herpes, i found this herbal man called Dr sunny on internet when i was doing research on cure for shingle i contacted him to found out if i can get help from this herpes virus, i was so surprise when he told me that he have the herbs cure to it and he sent me the herbal in less down 5 days i was so happy when i get someone giving me hope that he can cured me i took the herbal for just 2 weeks, when i went for test after taking the herbal i found out that i am cured i was so happy and surprise, i want to use this opportunity to inform you that there is cured to herpes virus you can also contact him for his help as soon as possible so that you can get rid of this herpes once and for all you can reach him through this email: drsunnyna@gmail.com or whatsApp him on +2348077875210 You can also contact him on any disease and virus in this he all have the herbal cure to it.
    1 HIV/AIDS
    2 HERPES
    3 CANCER
    4 ALS
    5 HEPATITIS
    6 DIABETES
    7 LOVE SPELL
    8 INFECTIONS
    9 HIGN BLOOD PRESSURE,.....
    THANKS TO DR SUNNY FOE THE GOOD WORK IN LIFE YOU ARE TRULY A BLESS.....

    ReplyDelete
  18. This is really serious, who will believe that a herb can cure herpes, i never believe that this will work, i have spend a lot getting drugs from the hospital to keep me healthy, it got to a time that i was waiting for death to come because i was broke, one day i hard about this great man called Dr Azaka who is well know for Herpes, HIV and Cancer cure, i decided to email him I didn't believe him that much, I just wanted to give him a try, he replied my mail and Needed some Information about me, then I sent them to him, he prepared a herbal medicine (CURE) and sent it through Online Courier Service for delivery, he gave my details to the Courier Office. they told me that 3-5 days I will receive the package and after receiving it, i took the medicine as prescribed by him at the end of the one week, he told me to go to the hospital for a check up, and i went, surprising, after the test the doctor confirm me Herpes simplex virus negative, i thought it was a joke, i went to other hospital and was also negative, thank you for saving my life, I promise I will always testify of your good works. if you are herpes simplex virus patient, OR you are be helping by someone before i will like to advice you to give this man a tryand see what will happen to your life don't worry about the money you have being using contact him and I am sure you, you will get cured, WhatsApp him on +2349059389105 or email via drazakaojezele@gmail.com Dr Azaka IS ALSO SPECIALISED ON(1) CANCER,(2) DIABETES,(3) HIV&AIDS,(4) URINARY TRACT INFECTION,(5) FIBROID,(6) IMPOTENCE,(7) BARENESS/INFERTILITY,(8) PREGNANCY,

    ReplyDelete
  19. All thanks to this great herbal doctor who cured me from (LUPUS DISEASE) his name is dr imoloa.  I suffered lupus disease for over 8 years with pains like: joints, Skin rash,  Pain in the chest,  swollen joints and many more.  The anti-inflammatory drugs couldn’t cure me, until I read about his recommendation. 2 months ago, I contacted him through his email address. drimolaherbalmademedicine@gmail.com . and he sent me the herbal treatment through DHL courier service and he instructed me on how to drink it for good two weeks. after then,  And I was confirmed cured and free at the hospital after taken his powerful herbal medications You too can be cured with it if interested, he also uses his powerful herbal healing medicine to cure disease like: parkison disease, vaginal cancer, epilepsy,  Anxiety Disorders, Autoimmune Disease,  Back Pain,  Back Sprain,   Bipolar Disorder,  Brain Tumour,  Malignant,  Bruxism, Bulimia,  Cervical Disk Disease, cardiovascular disease, Neoplasms,  chronic respiratory disease,  mental and behavioural disorder,  Cystic  Fibrosis,  Hypertension, Diabetes, asthma,  Inflammatory autoimmune-mediated arthritis.  chronic kidney disease, inflammatory joint disease, back pain,  impotence,  feta  alcohol spectrum,  Dysthymic Disorder,   Eczema, skin cancer,  tuberculosis,  Chronic Fatigue Syndrome, constipation, inflammatory bowel  disease, bone cancer, lungs cancer,  mouth ulcer,  mouth cancer, body pain, fever, hepatitis A.B.C.,   syphilis,  diarrhea,  HIV/AIDS,  Huntington's Disease,  back acne,  Chronic renal failure,   addison disease,  Chronic Pain,   Crohn's  Disease,   Cystic Fibrosis,  Fibromyalgia,   Inflammatory Bowel Disease,  fungal  nail disease, Lyme Disease, Celia disease, Lymphoma, Major  Depression,  Malignant Melanoma,   Mania,  Melorheostosis,   Meniere's  Disease,  Mucopolysaccharidosis , Multiple Sclerosis,  Muscular  Dystrophy,  Rheumatoid Arthritis, Alzheimer's Disease      Contacts him today  and get permanently cure. contact him via... email- drimolaherbalmademedicine@gmail.com  /whatssapp-+2347081986098.
    website-www drimolaherbalmademedicine.wordpress.com

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