Method of predicting the outcome of surgical treatment in Dupuytren's contractur based on leukocyte formula indices

Introduction World literature indicates the relevance of predicting the outcomes of Dupuytren's contracture (DC) treatment, including those based on laboratory methods. There are no comparative studies of the results of surgical DC treatment based on preoperative peripheral blood counts in the available literature. The purpose of the work was to identify possible differences in preoperative leukocyte counts in DC with  different outcomes of surgical treatment one year after surgery and to evaluate their prognostic significance.

Materials and methods The analysis of medical records of 52 DC patients operated on in the Hand Surgery Clinic of the Ilizarov Center in 2021–2022 was conducted. The results were assessed using the Khan scale, as well as by calculating the contracture reduction index (CRI). The subgroup included 111 patients with fair and poor results, the remaining 41 were included in subgroup 2 with good and excellent results.

Results According to the CRI values, the subgroups were in non-overlapping ranges. The percentage of eosinophils and basophils (B + E) in subgroup 1 was higher than in subgroup 2 (p < 0.05). ROC analysis of the "CRI — (B + E)" model revealed an area under the curve of more than 0.7 at p < 0.01, specificity of 100 %, sensitivity of less than 60 %. In patients with (B + E) < 1.2 %, the rate of excellent and good results one year after surgery was 95.23 %, with (B + E) ≥ 1.2 % 70.00 % (p < 0.05).

Discussion The role of eosinophils and basophils in the development of fascial fibromatosis is unknown, but it has been established that interleukins IL-4 and IL-13 secreted by mast cells, basophils and eosinophils directly contribute to the activation of myofibroblasts and the development of fibrosis.

Conclusion In (B + E) < 1.2 %, a favorable outcome is predicted for both open and minimally invasive surgeries; at (B + E) ≥ 1.2 % there is a high probability of progressive postoperative fibrosis, which justifies the choice of radical open interventions (hypodermectomy or dermofasciectomy) and the use of antifibrotic therapy in the postoperative period.

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