METHODS: The charts of all patients who received full-thickness skin grafts following dermofasciectomy for Dupuytren’s disease between 1986 and 2001 were reviewed. The surgical method employed dermofasciectomy followed by the harvesting of a full-thickness graft from the medial upper arm in a transverse fashion. Operative indications for the procedure were significant contracture or severe nodularity in a patient with Dupuytren’s diathesis (bilateral disease, the presence of knuckle pads or plantar nodules, family history). Records were examined for the following variables: sex, age at time of procedure, graft location, pre-operative and post-operative degree of contracture of the metacarpophalangeal and proximal interphalangeal joints, extension of disease post-operatively, recurrence of contracture, recurrence of disease in the graft site, alterations in sensation, pigment change, and the presence of knuckle pads or plantar nodules.

RESULTS: Dermofasciectomies with reconstruction using full thickness skin grafts were performed on 105 patients with Dupuytren’s contracture. This accounted for a total of 136 procedures and 249 grafts. Ninety-nine grafts were in the palm and the remaining 150 were in the digits. Nineteen patients underwent two procedures, three patients had three, and two (a father and son) each had four. There were 82 males (78.1%) and 23 females (21.9%). Age at the time of surgery ranged from 22 to 82 with a mean of 58.2. Ninety-nine of 105 patients (94.3%) presented for follow-up with the time ranging from one month to 141 months. Mean follow-up time was 22.8 months. Plantar nodules were seen in 25 (23.8%) patients and knuckle pads were observed in 16 (15.2%). Nine patients (8.6%) had both plantar nodules and knuckle pads. Extension of disease following surgery was seen in twenty patients ranging in time from one to 121 months. Mean extension time was 58.5 months. Three patients complained of decreased sensation in their graft sites and two patients complained of pigment changes. Recurrent contracture of the digits was seen in seven patients (6.7%) including one who had a recurrent metacarpo-phalangeal contacture as well. No recurrence of disease was seen in the graft sites themselves.

CONCLUSION: Dermofasciectomy with full-thickness skin grafting in the treatment of Dupuytren’s disease can eliminate the recurrence of disease in the graft site without any significant increase in morbidity or extension of disease.