Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren’s Contracture: A Prospective, Randomized, Controlled Trial (2017)

Sir: We congratulate Kan et al.1 for their interesting work on the treatment of Dupuytren’s disease. Studies with a prospective, randomized, controlled design are rare in surgery and therefore this work will improve the scientific background of surgical treatment. The authors analyzed the outcome of percutaneous aponeurotomy and lipofilling compared with limited fasciectomy in a short-term follow-up of 12 months. Kan et al. demonstrated significantly shorter convalescence and lower complication rates, and similar contracture correction and results 1 year postoperatively for percutaneous aponeurotomy and lipofilling compared with selective fasciectomy. Thus, they concluded that percutaneous aponeurotomy and lipofilling is a minimally invasive alternative to limited fasciectomy. Other authors showed similar results in treating Dupuytren’s disease with minimally invasive treatments. In a recent publication, Eaton summarized that patients treated with needle fasciotomy compared to limited fasciectomy are more satisfied with the procedure itself but that there is a significantly higher rate for recurrence.2 In the Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study,3 a recurrence rate of 35 percent at 3 years and 47 percent at 5 years after therapy with collagenase clostridium histolyticum was shown. In the longest available follow-up study (8 years), Watt et al. showed a recurrence rate of 75 percent after treatment with collagenase clostridium histolyticum.4 Van Rijssen et al. found recurrence rates of 85 percent at 5 years after needle fasciotomy and 21 percent after limited fasciectomy.5 With respect to all of these studies, a higher risk for recurrence after minimally invasive treatment of Dupuytren’s disease compared with selective fasciectomy can be concluded. Therefore, the demonstrated follow-up study by Kan et al. with a 1-year observation period is too short to adequately compare percutaneous aponeurotomy and lipofilling with selective fasciectomy. In addition, a less satisfactory result with regard to correction of contractures of the proximal interphalangeal joint was observed.1 Here, Zhou et al. found a significantly worse residual contracture of treated proximal interphalangeal joints with collagenase compared with selective fasciectomy.6 The contracture correction of the proximal interphalangeal joint reported by Kan et al. was better with selective fasciectomy even though there was no significance demonstrated. Minimally invasive treatment options for Dupuytren’s disease are increasing in popularity. Using these treatments, including percutaneous aponeurotomy and lipofilling in patients with Dupuytren’s disease, the advantages and disadvantages of each method should be considered by the surgeon and explained carefully to the patient. We are looking forward to further long-term results needed for percutaneous aponeurotomy and lipofilling. DISCLOSURE The authors declare no potential conflicts of financial interest with respect to the research, authorship, and/or publication of this communication. Sören Könneker, M.D.Christine Radtke, M.D., Ph.D.Peter Maria Vogt, M.D., Ph.D.Department of Plastic, Aesthetic, Hand, and Reconstructive SurgeryHannover Medical SchoolHannover, Germany