JofIMAB-2016-vol22-issue3

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hands were taken. We used Hueston table top test for preliminary evaluation of the contracture. Positive test indicates the presence of flexion contracture of the fingers. Contractures were measured with goniometer, placed on the dorsal aspect of the joint and results were recorded preoperatively, immediately postoperatively and in the follow- up period. Duiring the examination the passive extension deficit of the MCP, PIP and DIP joints was quantified in degrees and translated into total passive extension deficit (TPED) and classified according to Tubiana classification. (Graph.1) Graph. 1. Distribution of the patients in the Tubiana classification To evaluate the functional deficit we used the quick DASH score. We measured the satisfaction with the treatment with visual analogue scale (VAS). Clinical photographs of the hands were taken. Complications and satisfaction with the operation were scored and the patients were asked if they would choose the same procedure again and recommend it to a close person. For the purpose of this study we used the following inclusion criteria: 1. Positive Hueston table top test 2. Extension deficit of the Metacarpophalangeal joint (MCP) of at least 30 3. Extension deficit of the Metacarpophalangeal joint (MCP) of at least 20 and flexion contracture of Proximal interphalageal joint (PIP) at any degrees. 4. The presence of well-defined palmar cord 5. Reported functional deficit 6. Willingness to participate in the study The exclusion criteria were: 1. Patients generally unfit to have surgery 2. Patients who were not allowed to stop their anticoagulants 3. Patients who were not willing to participate in the study. surgical field, through two to three puncture wounds with epidural needle, we inject the subcutaneous fat with tumescent solution containing lidocaine and epinephrine. The solution is prepared with 5 x 10ml Lidocaine 2% , 1ml Epinephrine 0,1% in 1l of physiologic solution. (Fig. 1) We perform fat harvesting by manual liposuction with 10cc luer lock syringe connected with 12G (2,5mm) 7 hole cannula for fat harvesting. The collected lipoaspirate is allowed to settle for a while. (Fig. 2) Percutaneous needle aponeurotomy is performed on cleaned and draped hand. The planned portals are marked with surgical pen over the cord. (Fig. 3) For anesthesia we use Lidocaine 2%, injected only superficially in the skin of the planned portals. We prevent deeper infiltration of the anesthetic by using a very small needle 30G, 5mm. The cord is sectioned at many levels progressing from proximal to distal with 25G needle and under maximal tension. After each release a passive extension of the digit is performed to obtain maximal correction of the contracture. Then we prepare the subcutaneous space for lipofilling by division of the dermal attachments with epidural needle. We inject the through two or three portals the supernatant of the lipoaspirate using epidural needle. The quantity per ray is from 5 to 10 ml. (Fig. 4 and fig. 5) Postoperative care includes dressing and cast immobilization for 5 days. After this period the patient is allowed to return to his everyday life. Fig. 1. Infiltration of the subcutaneous fat tissue with tumescent solution Fig. 2. Fat harvesting with 12 G cannula and 10cc luer lock syringe Surgical technique Percutaneous needle aponeurotomy and lipografting includes three separate procedures of fat harvesting, percutaneous needle release and lipofilling. It is performed in an operating theater under sterile conditions. For donor sites for fat harvesting we use the region of abdomen, medial knee and thigh. After preparation of the 1302 http://www.journal-imab-bg.org / J of IMAB. <strong>2016</strong>, vol. 22, issue 3/
Fig. 3. Surgical portals are planned and marked Fig. 4. After sedimentation and removal of the lowest level which contain mainly blood and tumescent solution the lipoaspirate is ready to be injected Statistical analysis We used the tools of descriptive statistics and X 2 test to analyze statistical interaction between the presented risk factors and the degree of contracture. RESULTS We analyze the presented risk factors in the group for interactions with the degree of the contracture. It was not established a statistical significant relationship between preoperative values of TPED and the mentioned risk factors. (Table1) For evaluation of the flexion contraction we used the TPED of the most severely affected ray. Preoperatively the mean TPED measured 86, 33 and after treatment measured 22, 13 with mean improvement rate of 79% and difference in degrees from the preoperative value with 66, 06. The difference in preoperative and postoperative values of TPED is statistical significant (Table 2) Significance was set at p value of less than 0, 05. Immediately after release, the mean flexion contracture correction of the MCP joint was found from 44, 33° to 1, 8° degrees with 96, 03% improvement rate. Proximal interphalangeal joint contracture was reduced to 23, 75 residual contracture from preoperative value of 51, 25 and improvement rate of 56, 88%. (Table 3) The registered difference in distribution of patients in stages according to Tubiana classification is statistical significant (X 2 = 8.400, p
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