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Post-operative Management of Dupuytren's Disease with Topical Nitroglycerin: Case Report
Emelife PI, Kling RE, Wollstein R
University of Pittsburgh, Department of Surgery, Division of Plastic & Reconstructive Surgery
2012-02-16
Presenter: Russell Kling
Affidavit:
Students and I have worked together to develop this abstract. This abstract has not been sent to or published in a scientific journal, nor has this abstract been presented elsewhere.
Director Name: Ronit Wollstein
Author Category: Student
Presentation Category: Clinical
Abstract Category: Hand
How does this presentation meet the established conference educational objectives?
This case report suggests a novel way to manage Dupuytren's contracture post-operatively and will enable other institutions to explore and consider further studies in managing this disease.
How will your presentation be used by practicing physicians in the audience?
Practicing physicians could incorporate the use of topical nitroglycerin in the management of Dupuytren's contracture.
Introduction: Dupuytren's contracture remains an unsolved problem with significant complications and a recurrence rate of up to 60% . Commonly, the operated skin tends to rebuild scar in the area of surgery. The etiology of Dupuytren's contracture may involve local ischemia leading to scar formation in an abnormal distribution. This is supported by the relation of the disease to diabetes, liver disease, smoking, and hydantoin anticonvulsants since these conditions affect the peripheral nervous system and palmar circulation. Local ischemia may also explain the tendency of Dupuytren's disease to manifest or worsen subsequent to trauma. We used topical nitroglycerin post-operatively to prevent scar recurrence assuming that its use would prevent local ischemia.
Case presentation:
A 44-year-old man with a history of diabetes and Dupuytren's contracture treated surgically presented with bilateral palmar nodules. Pathological nodules and cords were excised in two separate surgeries. Following suture removal, he received a splint for two weeks and daily topical nitroglycerin. In this patient, the cream prevented raised scar formation during healing. Six months after surgery, there was no recurrence and the patient reported better healing while using topical nitroglycerin compared with previous surgeries.
Discussion: In this patient topical nitroglycerine use seemed to prevent recurrent scar formation.
To our knowledge, there is no literature citing the use of topical nitroglycerine post-operatively in cases of Dupuytren's contracture. Further study and follow-up is necessary.
Conclusion: Due to its vasodilatory properties, topical nitroglycerin may improve management of patients with Dupuytren's disease following surgery through prevention of local ischemia.
