In this video, Michael Neumeister, MD demonstrates Dupuytren’s excision of the fascia. Since recurrence is common in patients who are diagnosed with Dupuytren’s disease, Dr. Neumeister explains how the procedure can be significantly more complicated in patients who have previously undergone the procedure. He further explains various options to take into consideration when running into complications, such as flap loss, hematoma, infection, loss of flexion and ischemia to the finger.

Sponsored by the American Society of Plastic Surgeons^® (ASPS^®)
   
Author: Michael W. Neumeister, MD

 

This educational activity is intended for plastic surgery practitioners, residents, and other healthcare professionals interested in translating expanded knowledge into practice for the improvement of patient outcomes in plastic and reconstructive surgery.

 

Educational Overview

In this video, Michael Neumeister, MD demonstrates Dupuytren's excision of the fascia (otherwise known as Limited Fasciectomy, popularized by Hueston, 1961*). A series of videos puts you in the operating room from the Surgeon's point of view as Neumeister resects the diseased fascia that is causing contracture is removed under thin skin flaps in continuity with the pretendinous cord in the palm and the spiral chord and central cords in the digit. The incisions required for this procedure can be performed with Brunner incisions, modified to form Y-to-V advancements or longitudinal incisions with interposed Z-plasties. Once the central chord has been resected, the metacarpophalangeal joint contracture is completely released.  Since recurrence is common in patients who are diagnosed with Dupuytren's disease, Dr. Neumeister explains how the procedure can be significantly more complicated in patients who have previously undergone the procedure. He further explains various options to take when running into complications such as flap loss, hematoma, infection, loss of flexion, and ischemia to the finger.

*Hueston, J.T.. Limited fasciectomy for Dupuytren's contracture. Plastic and Reconstr. Surg. 27: 569, 1961.

 

Learning Objectives
Upon completion of the online course, the participant should be able to:

1. Understand the pathophysiology of Dupuytren's disease.

2. Know that Dupuytren's diathesis includes bilaterality, positive family history, ectopic Dupuytren's disease, Northern European origin, and onset is seen in more males.

3. Perform a Z-plasties to lengthen the skin shortage and thus, allowing normal range of motion for each digit. 

4. Be comfortable resecting the diseased fascia from the neurovascular bundles in the normal tissue, once the neurovascular bundles and artery have been isolated.

5. Overcome various complications that may occur during surgery.

 

Disclosures:
Dr. Neumeister has nothing to disclose.  All ASPS staff members managing this activity have no relevant financial relationships or affiliations to disclose.  All identified conflicts of interest have been resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity, and appropriateness of patient care recommendations.  The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a product are discussed in a CME activity or included in related materials.

Systems Requirements:
Participants must have internet access, browser software (either Chrome, Firefox, or InternetExplorer), Adobe Flash, and Adobe Reader. Supported Operating & Browser Systems: Microsoft Windows - IE7 or later, Firefox 3.x or later, Chrome 8.x or later. Macintosh Mac OS - Firefox 3.x or later, Safari 4.x or later. Linux - Firefox 3.x or later. Minimum Hardware Configurations: Windows - Intel Pentium II 450MHz or faster processor and 128MB of RAM. Macintosh - Power PC G3 500 MHz or faster processor OR Intel Core Duo 1.33GHz or faster processor and 128MB of RAM. Linux - Modern processor 800MHz or faster and 512MB of RAM with 128MB of graphics memory.

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