- Discussion:
- favored for advanced disease, especially in diabetics, and is indicated for patients w/ multiple involvement;
- use transverse incisions in the palm at the distal palmar crease, as well as transverse incisions at the base of fingers, and at PIP crease;
- limited fasciectomy is performed;
- when contractures are corrected, a gap of 3-4 cm may be present;
- phalangeal incisions are closed, palmar incisions are left open;
- either the palmar or digital wound, or both, may be left open, and in 4-6 weeks will heal into a fine linear scar;
- twice as many complications are seen in wounds closed primarily;
- open palmar wound does not heal simply by granulation, but by flattening of the transverse skin wrinkles;
- advantage of this is that early motion may be started & hematoma formation, pain, edema of hand, and joint stiffness are avoided in most
patients;
- Post Op:
- postoperative extension splinting is mandatory;
- only disadvantage in this technique is extra 2-3 weeks that are needed for complete healing to occur
The open palm technique in Dupuytren's contracture.