Plastic Surgery Consultation Summary for GP

Dear Dr. Patel

I reviewed Mr Arthur Pendelton on 24/10/2023. The matters discussed and the subsequent plan are outlined below.

Current Issues

• Progressive flexion contracture of the right ring and little fingers over the past 18 months.
• Functional impairment; difficulty placing right hand flat on a table and catching fingers when putting hand in pockets.
• Mild palmar nodule tenderness; no paraesthesia or vascular compromise.

Previous Medical Issues

• T2DM (diagnosed 2016)
• HTN
• Left carpal tunnel decompression (2019)

Current Medications/Treatments

• metformin 500 mg PO BID
• amlodipine 5 mg PO OD
• Penicillin allergy (maculopapular rash)
• Retired carpenter, lives with wife, right-hand dominant, ex-smoker (quit 10 years ago), 10 units EtOH/week.

Assessment

• Right hand Dupuytren's contracture affecting the 4th and 5th rays.
• O/E: Palpable palmar cords extending to the PIPJs of the ring and little fingers.
• Right ring finger: MCPJ contracture 30°, PIPJ contracture 45°. Hueston table top test positive.
• Right little finger: MCPJ contracture 20°, PIPJ contracture 20°.
• Intact digital neurovascular status; Allen's test normal, 2-point discrimination < 5 mm.
• Discussed non-operative management vs surgical intervention (percutaneous needle fasciotomy vs limited fasciectomy). Patient keen for definitive surgical release due to functional limitation.

Further Plan

• Listed for right ring and little finger limited palmar fasciectomy under regional block.
• Pre-operative assessment clinic referral initiated.
• Referral to Hand Therapy for post-operative night extension splinting and rehabilitation.
• Clinic review 2 weeks post-operatively for wound check and removal of sutures.

Yours sincerely, Mr Julian Vance, FRCS (Tr & Orth), Consultant Hand and Plastic Surgeon