Arterialized-Venous Flap for Soft Tissue Reconstruction for recalcitrant Dupuytren Contracture.

Abstract

The surgical treatment of severe Dupuytren contracture release remains a challenge. Although contracture recurrence is common after Dupuytren contracture release, treatments that focus on removing all diseased skin and tissue result in less recurrence and more durable results. In this article, we propose an innovative soft tissue reconstruction technique using a thin, pliable arterialized-venous flap for severe Dupuytren contracture after dermatofasciectomy. This approach aims to enhance both aesthetic and functional outcomes by providing vascularized, durable wound coverage and minimizing the risk of contracture recurrence. We have performed four arterialized-venous flaps for severe Dupuytren contracture in patients who were previously faced with the only surgical option of digit amputations. All arterialized-venous flaps survived without partial or total necrosis, and all patients demonstrated improved flexion contracture with no evidence of recurrence (average follow-up of 145.25 weeks). For patients with severe recurrent Dupuytren contracture or those with Dupuytren diathesis, which is associated with a poor prognosis, arterialized-venous flaps following dermatofasciectomy offers an advanced treatment option. This approach not only facilitates complete excision of the diseased skin and soft tissues but also provides well-vascularized, durable wound coverage, significantly reducing the risk of recurrent contracture.