Table 1.
Studies included in the analysis*
| No. | Authors (year) | Study design | No. of patients | No. of hands | No. of joints | Joint type | Follow-up period | Surgical techniques | Disease category |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Srivastava et al (1989)39 | Retrospective | 10 | 12 | NR | MP, PIP | 1–10 y | Fasciectomy, limited or radical; Z-plasty closure or open-palm technique; amputation for advanced disease | Mixed: Primary, 70%; recurrent, 30% |
| 2 | Sennwald (1990)27 | Retrospective | 98 | 103 | NR; 239 rays | NR | 3–6 mo | Fasciectomy, radical; rotation flap or Z-plasty | Mixed: Primary, 74.8%; recurrent, 25.2% |
| 3 | Moermans (1991)40 | Prospective | 175 | 213 | 503 | MP, PIP | Mean, 2.6 ± 1.6 y; range, 0–7 y | Aponeurectomy, segmental | Mixed: Primary, 83.1%; recurrent, 16.9% |
| 4 | Foucher et al (1992)41 | Retrospective | 107 | NR | NR; 140 digits | MP, PIP | >5 y | Fasciectomy, limited; open-palm technique and/or digit | Mixed: Primary, 95%; recurrent, 5% |
| 5 | Searle and Logan (1992)42 | Retrospective | 32 | NR | NR; 40 rays | NR | Mean, 38 mo; ≥24 mo | Dermofasciectomy | Mixed: Primary, 53%; recurrent, 47% |
| 6 | Beyermann et al (2004)43 | Prospective | 43 | 43 | 43 | PIP | 24 wk | Fasciectomy (n = 32), with CLM release (n = 11) | Mixed: Primary, 67.4%; recurrent, 32.6% |
| 7 | Meathrel and Thoma (2004)44 | Retrospective | 149 | NR | NR; 261 digits | NR | NR | Fasciectomy, palmar | Mixed: Primary, 87.2%; recurrent, 12.8% |
| 8 | Kobus et al (2007)45 | Retrospective | 253 | 287 | NR | MP, PIP | Mean, 3 y | Fasciectomy, radical, with V-Y–plasty | Mixed: Primary, 86.2%; recurrent, 13.8% |
| 9 | Loos et al (2007)4 | Retrospective | 2919 | 4388 | NR | MP, PIP, DIP | NR; data span 50-y period | Fasciectomy, limited (94.8% of procedures) or total; amputation | Mixed: Primary, 88%; recurrent, 12%; data not complete |
| 10 | Bulstrode et al (2005)46 | Retrospective | 253 | NR | NR | NR | Mean, 3.6 y; range, 9 mo–11 y | Fasciectomy, modified Skoog's technique | Mixed: Primary, 75.5% (191/253); recurrent, 24.5% (62/253) |
| 11 | Ebskov et al (1997)64 | Prospective | 76 | NR | NR; mean rays involved: primary, 2.1; recurrent, 1.8 | MP, PIP | 3 wk | Fasciectomy, radical, open-palm technique | Mixed: Primary, 68.4%; recurrent, 31.6% |
| 12 | Denkler (2005)30 | Retrospective | Hospital, 26; office, 40 | NR | Hospital, 73; office, 93; digits: hospital, 42; office, 60 | MP, PIP | Hospital: mean, 10.6 ± 21.9 mo; median, 3 mo; office: 9.3 ± 9.5 mo; median, 4 mo | Fasciectomy, hospital group (traditional anesthetics with tourniquet; 43 digits) vs office group (local anesthetics with epinephrine and no tourniquet; 60 digits) | Mixed: Hospital: primary, 88.5% (23/26); 11.5% (3/26); office: primary, 95.0% (38/40); 5.0% (2/40) |
| 13 | Andrew and Kay (1991)47 | Prospective | 46 | 50 | 79 | MP, PIP | 12 mo | Aponeurectomy, segmental | Primary, 100% |
| 14 | Liu and Chen (1991)48 | Retrospective | 27 | 32 | NR; 58 digits | NR | Mean, 5.3 y; range, 1–16 y | Fasciectomy with longitudinal, lazy-s, zigzag, or transverse incision | Primary, 100% |
| 15 | Robins et al (1993)49 | Prospective | 50 | 50 | NR | NR | NR | Fasciectomy, local; usually with zigzag incision | Primary, 100% |
| 16 | Cools and Verstreken (1994)50 | Retrospective | 28 | 33 | NR | MP, PIP | Mean, 2.5 y | Fasciectomy, partial; open-palm technique | Primary, 100% |
| 17 | Citron and Nunez (2005)51 | Prospective | 79 | 79 | NR | MP, PIP | ≥2 y | Fasciectomy, modified Bruner incision (n = 47) vs longitudinal incision with Z-plasty closure (n = 33) | Primary, 100% |
| 18 | Van Giffen et al (2006)52 | Retrospective | 38 | 38 | 63 (fifth ray only) | MP, PIP | Mean, 54 mo; range, 27–75 mo | Fasciectomy, isolated limited or segmental; dermofasciectomy | Primary, 100% |
| 19 | van Rijssen et al (2006)32 | Prospective | 113 | 117 | 127† | MP, PIP, DIP | 6 wk | Limited fasciectomy | Primary, 100% |
| 20 | Skoff (2004)53 | Prospective | 30 | NR | NR | MP, PIP | Synthesis: mean, 2.7 y; range, 2.0–3.0 y; open-palm technique: mean, 3.5 y; range, 3.1–4.0 y | Fasciectomy, “synthesis” technique (n = 20) vs open-palm technique (n = 10) | Primary, 100% |
| 21 | Ritchie et al (2004)54 | Prospective | 14 | 19 | 19 | PIP | Mean, 36 mo; range, 35–39 mo | Fasciectomy (8 little fingers), with CLM release (11 little fingers) | Primary, 100% |
| 22 | Misra et al (2007)55 | Prospective | 35 | NR | 52 | MP, PIP | Mean, 1.5 y; range, 1–3 y | Fasciectomy with Z-plasty (19 joints) ± PIP joint release (33 joints) | Primary, 100% |
| 23 | Sorene et al (2007)56 | Retrospective | 19 | 22 | 44 | IP, MP, PIP, DIP | Mean, 30 mo; range, 12–118 mo | Fasciectomy, selective, through modified Bruner palmodigital incisions | Primary, 100% |
| 24 | Stahl and Calif (2008)57 | Retrospective | 23 | 26 | NR | MP, PIP, DIP | Mean, 2.5 y; range, 1.5–19 y | Fasciectomy, limited, through zigzag digitopalmar incision ± CLM release of PIP joint | NR |
| 25 | Vigroux and Valentin (1992)58 | Retrospective | 56 | 76 | NR; 137 digits | MP, PIP | Mean, 12 y, 7 mo; range, 10–22 y | Fasciectomy, regional ± PIP capsulectomy | NR |
| 26 | Foucher et al (1995)59 | Retrospective | 54 | NR | NR; 67 digits | MP, PIP | Mean, 6.6 y; ≥5 y | Fasciectomy, open-palm technique | NR |
| 27 | De Maglio et al (1996)60 | Retrospective | 124 | 145 | NR | MP, PIP | Mean, 33 mo; range, 6–59 mo | Aponeurectomy, selective; Skoog's and/or Dieckman/Iselin routes of access | NR |
| 28 | Shaw et al (1996)61 | Retrospective | 25 | 26 | NR; 39 digits | MP, PIP | 9–19 y | Fasciectomy, palmar; open-palm technique | NR |
| 29 | Weinzweig et al (1996)62 | Retrospective | 28 | 42 | 42 | PIP | Mean, F, 10.1 mo; F + C, 6.4 mo | Fasciectomy (18 patients, 27 joints); F + C; 10 patients, 15 joints) | NR |
| 30 | Citron and Messina (1998)63 | Retrospective | 13 | NR | NR; 18 digits | PIP | Mean, 18 mo; range, 2–30 mo | Preoperative traction + fasciectomy ± fasciotomy | NR |
| 31 | Gonzalez et al (1998)74 | Retrospective | 16 | 19 | 40 | IP, MP, PIP | Mean, 25 mo; range, 6–168 mo | Fasciectomy, selective, with Z-plasty; fasciectomy, segmental, with multiple curvilinear incisions or Z-plasty | NR |
| 32 | Clibbon and Logan (2001)65 | Retrospective | 56 | 67 | 67 | MP | Mean, 30 mo; range, 12–86 mo | Aponeurectomy, segmental (palmar) | NR |
| 33 | Evans et al (2002)66 | Retrospective (1983–1993; TA only); prospective (1993–1999, TA and NTA) | 268 | NR | NR; mean number of digits undergoing surgery: 1.96 (TA); 1.6 (NTA)‡ | MP, PIP | NR | Fasciectomy, with TA (n = 103) or NTA (n = 165) | NR |
| 34 | Barr et al (2003)67 | Retrospective | 5 | 5 | 14 | MP, PIP | Mean, 14 mo; range, 3–34 mo | Fasciectomy, with Z-plasty + intramuscular tenotomy of flexor digitorum superficialis in distal forearm | NR |
| 35 | Abe et al (2004)68 | Retrospective | 57 | 73 | 146 | IP, MP, PIP | Mean, 4 y; range, 2–17 y | Fasciectomy, subtotal | NR |
| 36 | Ali et al (2006)69 | Retrospective | 32 | 35 | NR | NR | Mean, 6 mo; range, 2–13 | Fasciectomy, selective regional; ulnar-based skin flap | NR |
| 37 | Coert et al (2006)10 | Retrospective | 261 (558 operations) | 556 | MP, PIP, DIP | Mean, 7.3±0.44 y; range, 0.3–48 y | Fasciectomy, partial | NR; average number of operations was 2.54 per patient over 8-y study period | |
| 38 | Reuben et al (2006)70 | Prospective | 300 | NR | NR | NR | 1, 3, 12 mo postsurgery | Fasciectomy, with general anesthesia, axillary block, or intravenous regional anesthesia with lidocaine ± clonidine | NR |
| 39 | Anwar et al (2007)71 | Retrospective | 657; 109 women, 548 men | 119 women, 589 men | 123 women, 760 men | MP, PIP, DIP | NR | Fasciectomy, fasciectomy + local flap, dermofasciectomy | NR |
| 40 | Ekerot (1995)72 | Retrospective | 15 | 16 | NR; 17 flaps | MP, PIP | ≤2 y | Fasciectomy, radical, with distally based dorsal hand flap; PIP joint capsulectomy in 4 fingers | Recurrent, 100% |
| 41 | Roush and Stern (2000)73 | Retrospective | 19 | NR | NR; 28 digits | MP, PIP, DIP | Median, 4 y; range, 1–15 y | Fasciectomy, limited, and IP arthrodesis; dermofasciectomy; fasciectomy and local flaps | Recurrent, 100% |
*NR indicates not reported; TA, tension applied; NTA, no tension applied; MP, metacarpophalangeal; PIP, proximal interphalangeal; DIP; distal interphalangeal; IP, interphalangeal; fasciectomy + capsulotomy; capsuloligamentous.
†An additional 150 joints were treated with percutaneous needle fasciotomy but were excluded from this analysis.
‡An additional 150 finger joints were treated with percutaneous needle fasciotomy but were excluded from this study since this study is discussingcomplications of surgical fasciectomy (excsion) for Dupuytren's.