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Use of Acellular Dermal Matrix in Dupuytren's Contracture
Gloria R. Sue, M.A.1, Michael J. Terry, M.D.2, Carolyn Goldberg, M.D.1, Deepak Narayan, M.D.1.
1Yale University, New Haven, CT, USA, 2New York University, New York, NY, USA.
Background: Various surgical treatment modalities have been advocated for the treatment of Dupuytren’s contracture. However, recurrence following surgical treatment of Dupuytren’s contracture remains a common problem. Prior studies have demonstrated lower recurrence rates with use of a full-thickness skin graft. We postulated that the use of acellular dermal matrix may be associated with a similar outcome, based on the common inhibitory effect on underlying myofibroblasts. The purpose of this study is to determine whether the use of acellular dermal matrix is associated with decreased recurrence rates in Dupuytren's contracture.
Methods: We performed a retrospective cohort study of 43 patients undergoing open fasciectomy for Dupuytren’s contracture from years 2005 through 2012 performed by a single surgeon at our academic institution. Standard fascietcomies of the affected palmar and digital fascia were performed via Brunner incision on all patients. Patients in the experimental group had a sheet of acellular dermal matrix (Alloderm, LifeCell, Bridgewater, NJ) sutured into the surgical bed prior to closure, whereas patients in the control group were not closed with acellular dermal matrix. Patients were then evaluated at follow-up for disease recurrence, defined as presence of Dupuytren’s tissue in an area previously operated on, with a contracture greater than that recorded following the surgical fasciectomy.
Results: Among our cohort of 43 patients, 23 (53.5%) were treated with acellular dermal matrix while 20 (46.5%) were not. The median age of our cohort was 66.5 years (range 54 to 91 years). The median follow-up was 1.8 years. During this follow-up period, recurrence of contracture was observed in 1 of 23 patients in the experimental group, compared to 5 of 20 in the control group (P = 0.045). No differences in the incidence of minor wound complications were observed.
Conclusions: We observed lower recurrence rates in our cohort of patients who were treated with placement of acellular dermal matrix into the wound bed following open fasciectomy for Dupuytren’s contracture. Our novel technique has implications for future surgical treatment strategies to reduce recurrence rates in Dupuytren’s contracture.
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