The palmar intermetacarpal flap in Dupuytren's contracture

Skin Expansion Due to the Dupuytren Cord Allows to Design Local Flaps to Facilitate Skin Closure in Severe Cases: The 3-flap: Surgical Technique and Clinical Evaluation

In the serious forms of Dupuytren disease, passive extension during surgery often results in unmasking a loss of skin substance that makes primary closure impossible. Our objective in this study was to describe and assess the therapeutic possibilities of a 3 local flaps surgical approach in serious forms of Dupuytren disease, using the lateral skin expansion because of the cord. A cadaveric study was carried out on 12 adult nonembalmed, fresh frozen hands. For each specimen, a loss of skin substance was simulated on the palmar side of the fifth finger at the level of the proximal digital flexion crease. Coverage involved an incision delineating 3 distinct local flaps: a radially based quadrangular palmar flap, triangular proximally based laterodigital flap, and a distally based triangular web space flap. For a defect reaching up to 40% of the palmar surface of the first phalanx (P1), this 3-flap combination allowed us to fill in skin loss with a tension-free closure. Then we led a clinical study among 10 patients suffering from Dupuytren contracture, Tubiana, and Michon classification stages from II to IV. For those patients who all showed perioperative inadequate skin coverage, we used the 3-flap plasty. No skin necrosis occurred. This reliable technique using a "cascade" of local flaps makes it possible, in serious forms of Dupuytren disease, to both easily access the palmar and digital portions of the cord and to achieve closure.

Anatomical study of the palmar intermetacarpal perforator flap

The authors present an anatomical study of a small flap that may be harvested from any of the palmar intermetacarpal spaces while performing fasciectomy in Dupuytren's contracture. The flap is diamond-shaped, vascularised by two perforating branches originating from the underlying true digital arteries and may be rotated through 90 degrees to 180 degrees in either direction to provide skin cover and subcutaneous padding over the distal palm and/or the base of the finger.