Simultaneous carpal tunnel release and Dupuytren's fasciectomy.

PURPOSE: To determine whether members of the American Society for Surgery of the Hand (ASSH) consider it safe to perform concurrent carpal tunnel release (CTR) and Dupuytren fasciectomy, and to report our own experience with simultaneous CTR and fasciectomy. METHODS: An e-mail survey was sent to all active members of the ASSH regarding their preferences in the concurrent surgical management of carpal tunnel syndrome and Dupuytren's disease. In addition, 70 patients who had had simultaneous CTR and Dupuytren's fasciectomy were identified in a retrospective chart review from a 7-person hand surgery group. Data on the severity of disease and risk factors for intraoperative, early, and late complications were collected for these patients. Comparison groups of 50 patients having fasciectomy alone and 50 patients having CTR alone were also compiled for internal comparison. RESULTS: The survey response rate was 50% (698/1399 respondents). Fifty percent of the responding ASSH members replied that they would not or would only sometimes perform these 2 procedures together because of concern for the development of complex regional pain syndrome and postoperative stiffness. Two of 70 patients experienced a transient pain flare, and 1 of 70 experienced stiffness, which was comparable to internal and literature controls for Dupuytren's fasciectomy alone. CONCLUSIONS: Controversy exists among ASSH members in regard to treating carpal tunnel syndrome and Dupuytren's disease simultaneously. Based on our findings, we recommend performing both of these procedures at the same surgical session, thereby dispelling the myth that simultaneous surgery has an increased complication rate.

Complications after treatment of flexor tendon injuries.

The goals of flexor tendon repair are to promote intrinsic tendon healing and minimize extrinsic scarring in order to optimize tendon gliding and range of motion. Despite advances in the materials and methods used in surgical repair and postoperative rehabilitation, complications following flexor tendon injuries continue to occur, even in patients treated by experienced surgeons and therapists. The most common complication is adhesion formation, which limits active range of motion. Other complications include joint contracture, tendon rupture, triggering, and pulley failure with tendon bowstringing. Less common problems include quadriga, swan-neck deformity, and lumbrical plus deformity. Meticulous surgical technique and early postoperative tendon mobilization in a well-supervised therapy program can minimize the frequency and severity of these complications. Prompt recognition of problems and treatment with hand therapy, splinting, and/or surgery may help minimize recovery time and improve function. In the future, the use of novel biologic modulators of healing may nearly eliminate complications associated with flexor tendon injuries.