RANDOMIZED CONTROLLED TRIAL OF LIMITED FASCIECTOMY WITH INJECTION OF ADIPOSE GRAFT FOR DUPUYTREN’S DISEASE

Dupuytren’s disease is a genetic disorder related to the proliferation of myofibroblasts. The pluripotent property of stem cells present in adipose tissue inhibits myofibroblast proliferation. Our study sought to evaluate the effect of stem cell-rich fat grafts in patients that underwent limited fasciectomy.

Methods:

We studied 45 patients, in a single-blind, prospective, randomized clinical trial. All patients underwent limited fasciectomy. In one group, fat graft was injected.

Results:

The total passive extension deficit results did not exhibit a significant difference. Fat group exhibited worse functional score at 6 months and 1 year postoperatively, such as higher complication rates (43%), when compared with control group (8%), and more pain at 6 weeks follow-up.

Conclusion:

Fat grafting associated with limited fasciectomy promotes worse functional results compared to conventional limited fasciectomy in the short term. However, long-term results and recurrence rates should be further assessed. Level of Evidence II, Prospective comparative study.

Keywords:
Dupuytren Contracture; Adipose Tissue; Fasciectomy; Stem Cells; Randomized Controlled Trial; Clinical Trial

Groups
	Control group		Fat group
Tubiana Stage	N	%	N	%
I (0º-45º)	5	21%	4	19%
II (45º-90º)	10	42%	11	52%
III (90º-135º)	8	33%	4	19%
IV (≥ 135º)	1	4%	2	10%
Total	24	100%	21	100%

Groups
		Control group		Fat group		p
		N	%	N	%	p
Gender	Male	20	83%	14	67%
	Female	4	17%	7	33%
	Total	24	100%	21	100%	0.176
Dominant side	Yes	13	54%	7	33%
	No	11	46%	14	67%
	Total	24	100%	21	100%	0.212
Presence of nodules	Yes	23	96%	19	90%
	No	1	4%	2	10%
	Total	24	100%	21	100%	0.592
Presence of cords	Yes	24	100%	19	90%
	No	0	0%	2	10%
	Total	24	100%	21	100%	0.212

	N	Median	Minimum	Maximum	p
Pre-Operative
Control	24	2	0	9	0.616
With fat	21	5	0	9
6 weeks
Control	24	0	0	5	0.045*
With fat	21	2	0	9
6 months
Control	24	0	0	5	0.487
With fat	21	0	0	9
1 year
Control	24	0	0	5	0.864
With fat	21	0	0	9

	N	Median	Minimum	Maximum	p
Pre-operative
Control	24	77.50	35	150	0.784
With Fat	21	75.00	25	155
6 weeks
Control	24	15.00	0	55	0.198
With Fat	21	25	0	65
6 months
Control	24	10.00	0	45	0.101
With Fat	21	15.00	0	130
1 year
Control	24	10.00	0	60	0.151
With Fat	21	25.00	0	135

	N	Median	Minimum	Maximum	p
Pre-operative
Control	24	55.20	11.13	89.58	0.241
With Fat	21	60.41	27.08	89.58
6 weeks
Control	24	79.16	43.75	97.91	0.121
With Fat	21	23.66	22.72	100.00
6 months
Control	24	92.70	50.00	100.00	0.040*
With Fat	21	83.33	25.00	100.00
1 year
Control	24	91.28	64.58	100.00	0.047*
With Fat	21	87.50	43.75	96.03

Groups
	Control group		Fat group		p
Intercurrences	N	%	N	%	p
Infection	0	0%	1	5%
Dehiscence	1	4%	2	10%
Hematoma	0	0%	1	5%
CRPS	1	4%	4	19%
Hypertrophic scar	0	0%	1	5%
Total	2	8%	9	43%	0.019

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[1] Correspondence: Marina Tommasini Carrara de Sambuy. Rua Dona Adma Jafet, 74, cj 144, São Paulo, SP, Brazil, 01308050. marinacarrara@hotmail.com