Reply: Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren’s Contracture

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We would like to thank Könneker et al. for their response to our article.1 In this article, we introduced an innovative extensive percutaneous aponeurotomy and lipofilling (PALF) technique and described the early results. In a former study,2 we described the surgical method and the first cohort of patients, reporting a significant improvement of metacarpophalangeal and proximal interphalangeal joint contracture correction. Although this initial study suggested that percutaneous aponeurotomy and lipofilling shortens recovery time, adds to the deficient subcutaneous fat, and leads to scarless supple skin, this study did not include a comparison group. Therefore, a randomized controlled trial was needed to directly compare this new treatment with a gold standard. As Könneker et al. also stated, these more rigorous designs are presently rare in surgery and are needed to provide more convincing evidence for choosing optimal treatment in individual patients.
As Könneker et al. also pointed out, in our single-blind, multicenter, randomized trial1 comparing the effectiveness of percutaneous aponeurotomy and lipofilling with limited fasciectomy, no significant differences in contracture correction between groups were detected. In addition, the patients in the percutaneous aponeurotomy and lipofilling group returned significantly earlier to their normal daily activity. At 1 year after surgery, no significant differences in recurrence rate and hand function were present. It is interesting and counterintuitive that in our recent discrete choice study patients preferred low recurrence rates and less extension deficit above the short convalescence.3 However, as stressed in the letter, for both the prospective cohort and the randomized controlled trial, no long-term follow-up data beyond 1 year are yet available. Therefore, long-term recurrence rates cannot be presented. In the near future, fortunately, we will be able to present the 5-year follow-up of the patients treated with percutaneous aponeurotomy and lipofilling and limited fasciectomy in our trial.
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