Clinical case - After dermo-fasciectomy - Stage 4 dupes of LEFT ring finger
Any ideas of what to do?
67 yr old business man.
I performed a dermo-fasciectomy for stage 4 dupes of his LEFT ring finger on 28-07-2017.
He had a stormy post op course with haematoma that need evacuated twice and a persistent flexion contracture that caused me to k-wire the DIPJ and PIPJ (never have I done that before or after!).
Anyway he has recontacted in the last week to asking me to sort out his finger! He has decided not to go anywhere else for treatment which I suppose is a good thing.
He has sent me photos which are in a word document attached. I haven’t seen him yet but am reaching out for advice please prior to seeing him. I think perhaps a scar revision and fusion of the PIPJ might work. What do you think?
I’d love to hear you thoughts.
Phil Grieve - Irland
Interesting case. Does he have any flexion in PIP or is it fixed in hyperextension
Docteur Bernard Cadot - France
Great correction, Phil! Scar excision and generous (diamond shaped?) graft sounds reasonable. As to the PIPJ I guess if the X ray is OK would try and treat as a fixed SND and do a dorsal release. Possibly best done separately to ensure he doesn’t get stiff afterwards. But if joint painful agree fusion is reasonable.
Will Mason - United Kingdom
I probably would go for a fusion of PIPJ
Mit freundlichen Grüßen/Best regards
Dr. Eva-Maria Baur - Germany