Injection of local anaesthetic into the palmar tissues during percutaneous needle aponeurotomy for Dupuytren’s disease can be painful. Commercial lignocaine is acidic, and buffering with sodium bicarbonate may reduce infiltration discomfort by raising pH toward physiological levels. Needle gauge may also influence pain at needle entry. This randomised controlled trial evaluated the effects of lignocaine buffering and needle gauge on patient reported pain during percutaneous needle aponeurotomy. In a single centre, single blind, randomised design, adults undergoing percutaneous needle aponeurotomy were allocated to receive either one percent lignocaine buffered with 8.4 percent sodium bicarbonate at a 10 to 1 ratio or plain one percent lignocaine. Participants were also allocated to infiltration using either a 25 gauge or 27 gauge needle. Pain was recorded on a ten point visual analogue scale, separately for needle insertion and for local anaesthetic infiltration. Immediate adverse events were recorded. Sixty seven patients were included. Buffered lignocaine significantly reduced infiltration pain compared with plain lignocaine, with a mean reduction of 1.65 visual analogue scale points and no adverse events. Needle gauge did not significantly affect needle insertion pain, with no meaningful difference between 25 gauge and 27 gauge needles. Buffering lignocaine with sodium bicarbonate is a simple, safe, and cost effective method to reduce infiltration pain during percutaneous needle aponeurotomy. Within the tested range, needle gauge does not meaningfully alter needle insertion pain.

Purpose Recurrent contractures after fasciectomy and z-plasty for Dupuytren’s Fibrosis occur in 40% of cases with an estimated serious adverse event (SAE) of 1 to 3%. It has been documented that Dupuytren's fibrosis occurs extremely rarely under a full-thickness skin graft performed after dermofasciectomy. The current study aims to describe the surgical technique and post-operative management for primary dermofasciectomy with a full-thickness skin graft. It also aims to show rates of recurrent contractures in patients following this procedure. Methodology This retrospective study was performed from 2016-2023. All patients had a dermofascietomy with full-thickness grafts from the distal segment to the level of the mid-palmar crease. Total flexion deformities (TFD) were recorded pre- and post-surgery and were classified using Tubiana’s staging (REF). Patients' follow-up ranged from 6 months to 5.5 years. Recurrence was defined as contracture of >20 ̊from 6-week measurements. Results 118 patients and 142 fingers were included in the study. The average follow-up time was 18.7 months. A recurrent contracture rate of 21.8% was recorded. Of these, 61.3% (n=19) had improved overall TFD measures, but had a recurrence of contracture more than 20 degrees when compared to 6-week follow-up; 16.1% (n=5) had no improvement in TFD; and 22.6% (n=7) had worse TFD at the end of their follow-up compared to pre-treatment measures. The average time to recurrent contracture was 12.4 months. No recurrence of Dupuytren’s fibrosis was identified in the patients who experienced recurrent contractures. Conclusions The current study provides an interesting insight into the evolution of Dupuytren’s Disease. While we have demonstrated that dermofasciectomy with FTG abolishes recurrent Dupuytren's fibrosis, there remain problems with recurrent contractures and loss of motion. This raises the interesting question: ‘In the absence of disease, what is the cause for recurrent contractures?’

Hands present a particular challenge when it comes to soft tissue reconstruction due to the highly functional nature of the area and the intricate structural features that define the anatomy. Novosorb BTM, a synthetic dermal substitute, is increasingly being utilised as a solution for many of the problems that face hand reconstruction. This presentation summarises a cohort of 10 patients who underwent hand reconstruction via BTM at a Far North Queensland hospital between 2020-2024. The most common indication for reconstruction was following oncological resection. The majority of patients went on to have second stage reconstruction with a split thickness skin graft. Of particular interest is that despite multiple patients experiencing either BTM infection or graft infection, all patients achieved wound closure, with 4 out of 5 working patients being able to return to their usual work duties afterward. Aside from infection, no other complications were recorded. A drawback would be the longitudinal course of this reconstructive process, with patients taking on average 6.5 weeks to proceed to grafting and 10.6 weeks from BTM application until healed. Comparison of QuickDASH measures with patient characteristics suggested that poorer functional outcomes were obtained in comorbid patients or those that engaged poorly with hand therapy. This study provides a point of comparison against other recent literature examining BTM indications and outcomes for hand reconstruction outside of Australia, as well as highlighting the emerging role for BTM in a resource-limited regional location.