Application of Near Infrared Spectroscopy to Enhance Safety and Individualize Distraction of Severely Contracted Joints in Far-Advanced Dupuytren’s Disease

Background: Slow distraction of contracted joints is a well-established treatment in far-advanced stages of Dupuytren's disease (DD). To assess finger perfusion and avoid malperfusion, we studied near infrared spectroscopy (NIRS) to evaluate the maximum extent of distraction that would not harm microcirculation to the finger. This technique also allows an optimized treatment in accordance with sufficient blood perfusion during distraction. Methods: Eligible patients with stage IV finger contractures who needed treatment for Dupuytren's contracture were included and prospectively investigated. The operation was performed with local anaesthesia. First, the Dupuytren strand of the treated finger was dissected in the palm to allow distraction. Under X-ray control, the distraction device was applied. Then, slow distraction of the treated joint was performed to evaluate the finger perfusion. To assess perfusion of the treated finger, NIRS was used to measure tissue oxygen saturation. If impaired finger perfusion was detected, traction was reduced until sufficient oxygen levels and perfusion patterns were reestablished. Results: NIRS was performed after application of the distraction device in seven cases. We treated six male and one female patient (mean age 70 years, range 51-80 years). Rapid distraction resulted in malperfusion of the treated fingers. Using NIRS proved to render reliable and reproducible information on finger perfusion and oxygenation in all seven patients. Conclusions: Application of NIRS enhances safety in the treatment of far-advanced DD finger contractures with an external skeletal distraction device. It is non-invasive, reproducible, easy to use and allows for an individualized adapted distraction velocity.