Three useful ways to avoid amputation in advanced Dupuytren's contracture.

Every surgeon dealing with Dupuytren's contracture will meet patients in whom the volar skin in a finger either is too scarred or is insufficient and skin coverage is necessary. In some cases the possibilities for volar fasciectomy have been exhausted: the deep structures are so heavilv involved in the scar that volar surgery is impossible. Of ten an amputation appears inev i tab le -bu t aged patients will always be happer if another solution can be suggested. It is astonishing that so little is written about this problem. T h e papers by Brunei", by Hueston, by Skoog, and f rom the "Groupe d 'Etude de la Main" have indeed very little to say about this not at all uncommon situation. I have used three different methods for years to overcome these problems: the cross finger flap, the athrodesis with shortening at the proximal interphalangeal joint and sometimes even of the distal interphalangeal joint, and wedge osteotomy distally in the proximal phalanges with healing in dorsal angulation.