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Fasciotomia Percutânea com Agulha vs Fasciectomia na Doença de Dupuytren: Uma Revisão Sistemática
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Advisor(s)
Abstract(s)
Introdução: A doença de Dupuytren (DD) é uma doença fibroproliferativa, comum e nãomaligna da fáscia palmar, caracterizada por nódulos e cordões fibróticos que condicionam
contraturas em flexão digital, mais comumente no quarto e quinto dedo. O tratamento não
é curativo, sendo a abordagem expectante e conservadora adequada para alguns. Contudo,
o tratamento é indicado quando a progressão da doença implica repercussões na vida do
utente. De entre as opções terapêuticas, destaca-se a fasciotomia percutânea com agulha
(PNF) e a fasciotomia (OF), que serão comparadas tendo em conta variáveis primárias:
resolução da contratura, recidiva e complicações, e variáveis secundárias: satisfação dos
utentes e melhoria funcional, custo-efetividade e tempo de recuperação.
Métodos: Foi realizada uma revisão sistemática da literatura sobre as variáveis em estudos
da fasciotomia percutânea com agulha (percutaneous needle fasciotomy - PNF) e da
fasciectomia (open fasciectomy - OF), tendo como base as Guidelines PRISMA 2020.
Foram utilizadas as bases de dados Pubmed/MEDLINE, Scopus e B-On, com a equação
(("Dupuytren* Contracture" OR "Dupuytren* disease") AND ("Percutaneous needle
fasciotomy" OR PNF OR "Open fasciectomy" OR OF)). Com base na estratégia PICO, foram
incluídos estudos que abordaram a fasciotomia percutânea e a fasciectomia, excetuando
revisões sistemáticas e meta-análises. No total, foram encontrados 1421 artigos nas três
bases de dados, dos quais 12 foram selecionados.
Resultados: Procedeu-se à análise comparativa entre a fasciotomia percutânea e a
fasciectomia, tendo em conta variáveis primárias: a resolução da contratura, recidiva e
complicações, e variáveis secundárias: satisfação dos utentes e melhoria funcional, custoefetividade e tempo de recuperação. A PNF apresenta uma melhor recuperação e uma
menor taxa de complicações, associada a uma maior taxa de recidiva. A OF apresenta uma
melhor resolução da contratura a longo prazo com menor taxa de recidiva, associada a uma
maior taxa de complicações e a uma recuperação mais demorada.
Conclusão: Os resultados desta revisão não permitem retirar nenhuma ilação conclusiva
sobre qual o melhor método. A PNF pode ser o método de eleição em pessoas mais idosas
ou em pessoas que beneficiem de uma recuperação mais rápida, ao passo que a OF pode ser
a preferência de utentes mais jovens. Assim, quer o utente quer o médico beneficiam de uma
abordagem centrada no utente guiada por uma decisão partilhada.
Introduction: Dupuytren’s disease (DD) is a common, non-malignant and fibroproliferative disorder of the palmar fascia, characterized by nodules and fibrotic cords that cause digital flexion contractures, most commonly affecting the fourth and fifth fingers. Treatment is not curative, and a watchful and conservative approach may be adequate for some patients. However, intervention is warranted when disease progression significantly impacts the patient’s quality of life. Among the therapeutic options, percutaneous needle fasciotomy (PNF) and open fasciectomy (OF) stand out; these techniques will be compared with respect to primary outcomes: contracture resolution, recurrence and complications, as well as secondary outomes: patient-satisfaction and functional improvement, cost-effectiveness and recovery time as secondary outcomes Methods: A systematic literature review was conducted on the variables reported in studies of PNF and OF based on PRISMA 2020 Guidelines. The databases Pubmed/ MEDLINE, Scopus and B-on were searched using the equation: (("Dupuytren* Contracture" OR "Dupuytren* disease") AND ("Percutaneous needle fasciotomy" OR PNF OR "Open fasciectomy" OR OF)). Based on the PICO strategy, studies addressing PNF and OF were included, excluding systematic reviews and meta-analyses. A total of 1421 articles were found across the three databases, of which 12 were selected. Results: A comparative analysis between percutaneous fasciotomy and open fasciectomy was conducted, considering contracture resolution, recurrence and complications as primary outcomes, and patient-satisfaction, cost-effectiveness and recovery time as secondary outcomes. On one hand, PNF provides faster recovery and lower complications rates, despite being associated with a higher recurrence rate. On the other hand, OF offers a better long-term resolution of the contracture with lower recurrence rates, although being associated with higher complications and longer recovery time. Conclusion: The results of this review do not allow for a definitive conclusive on the superior method. PNF may be the preferred option for older individuals or those who benefit from a faster recovery, whereas OF may be more suitable for younger patients who might benefit from a minor risk of recurrence. Ultimately, both the patient and the physician benefit from a patient-centered approach guided by shared decision-making.
Introduction: Dupuytren’s disease (DD) is a common, non-malignant and fibroproliferative disorder of the palmar fascia, characterized by nodules and fibrotic cords that cause digital flexion contractures, most commonly affecting the fourth and fifth fingers. Treatment is not curative, and a watchful and conservative approach may be adequate for some patients. However, intervention is warranted when disease progression significantly impacts the patient’s quality of life. Among the therapeutic options, percutaneous needle fasciotomy (PNF) and open fasciectomy (OF) stand out; these techniques will be compared with respect to primary outcomes: contracture resolution, recurrence and complications, as well as secondary outomes: patient-satisfaction and functional improvement, cost-effectiveness and recovery time as secondary outcomes Methods: A systematic literature review was conducted on the variables reported in studies of PNF and OF based on PRISMA 2020 Guidelines. The databases Pubmed/ MEDLINE, Scopus and B-on were searched using the equation: (("Dupuytren* Contracture" OR "Dupuytren* disease") AND ("Percutaneous needle fasciotomy" OR PNF OR "Open fasciectomy" OR OF)). Based on the PICO strategy, studies addressing PNF and OF were included, excluding systematic reviews and meta-analyses. A total of 1421 articles were found across the three databases, of which 12 were selected. Results: A comparative analysis between percutaneous fasciotomy and open fasciectomy was conducted, considering contracture resolution, recurrence and complications as primary outcomes, and patient-satisfaction, cost-effectiveness and recovery time as secondary outcomes. On one hand, PNF provides faster recovery and lower complications rates, despite being associated with a higher recurrence rate. On the other hand, OF offers a better long-term resolution of the contracture with lower recurrence rates, although being associated with higher complications and longer recovery time. Conclusion: The results of this review do not allow for a definitive conclusive on the superior method. PNF may be the preferred option for older individuals or those who benefit from a faster recovery, whereas OF may be more suitable for younger patients who might benefit from a minor risk of recurrence. Ultimately, both the patient and the physician benefit from a patient-centered approach guided by shared decision-making.
Description
Keywords
Doença de Dupuytren Fasciectomia Fasciotomia Percutânea com Agulha