An Investigation into the Role of Inflammatory Cells in Dupuytren’s Disease

1991 ◽  
Vol 16 (3) ◽  
pp. 267-271 ◽  
Author(s):  
J. G. ANDREW ◽  
S. M. ANDREW ◽  
A. ASH ◽  
B. TURNER
Keyword(s):  
Inflammatory Cells ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Palmar Fascia ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Microvascular Changes ◽  
Macrophage Marker ◽  
Fibrotic Diseases

An immunohistochemical study was performed on nodules excised from the palmar fascia of patients with Dupuytren’s contracture. In cellular nodules, antibodies to actin (used as a marker for myofibroblasts), desmin, vimentin, Mac 387 (a macrophage marker) and leucocyte common antigen were used. A correlation was demonstrated between the numbers of macrophages and the presence of myofibroblasts. The presence of myofibroblasts is generally considered to indicate the active stage of the disease. Inflammatory cells other than macrophages were largely absent from the nodules, although lymphocytes were frequent in the tissue around the nodules. Microvascular changes were prominent in the nodules and pericyte proliferation was observed around occluded capillaries. Release of growth factors from macrophages may be important in Dupuytren’s contracture, as is the case in other fibrotic diseases. The possible role of macrophages in the aetiology of Dupuytren’s disease is discussed.

The Effect of Steroids on Dupuytren’s Disease: Role of Programmed Cell Death

2002 ◽  
Vol 27 (3) ◽  
pp. 270-273 ◽  
Author(s):  
R. M. D MEEK ◽  
S. McLELLAN ◽  
J REILLY ◽  
J. F. CROSSAN
Keyword(s):  
Cell Death ◽  
Inflammatory Cells ◽  
Fascia Lata ◽  
Dupuytren’S Disease ◽  
Fibroblast Proliferation ◽  
Palmar Fascia ◽  
Dupuytren's Disease ◽  
Proliferation And Apoptosis ◽  
And Control

This study compared the rates of proliferation and apoptosis of cells within nodules of Dupuytren’s disease and nodules from patients that had been injected preoperatively with steroid (Depo-Medrone). It also compared the effects of steroids in apoptosis in cultured Dupuytren’s cells and control fibroblasts from palmar fascia and fascia lata. Steroids reduced the rate of fibroblast proliferation and increased the rate of apoptosis of both fibroblasts and inflammatory cells in Dupuytren’s tissue. Steroids also produced apoptosis of cultured Dupuytren’s cells but not of palmar fascia and fascia lata cells.

scholarly journals Dupuytren’s Contracture with Secondary Ulnar Neuropathy

2020 ◽  
Vol 11 (03) ◽  
pp. 481-483
Author(s):  
Chen Fei Ng
Keyword(s):  
Diabetes Mellitus ◽  
Clinical Symptoms ◽  
Chronic Alcoholism ◽  
Ulnar Neuropathy ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Hand Trauma ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Patients With Diabetes

AbstractDupuytren’s disease is a progressive fibrotic condition of the hand. The underlying pathomechanism is not fully known. Dupuytren’s contracture can be seen in patients with diabetes mellitus, chronic alcoholism, smoking, or hand trauma. It is uncommon to affect the neurovascular supply causing clinical symptoms. We describe a patient with idiopathic Dupuytren’s disease complicated with bilateral ulnar neuropathies and highlight the importance of such rare treatable complication.

Langerhans Cells in Dupuytren’s Contracture

2001 ◽  
Vol 26 (4) ◽  
pp. 362-367 ◽  
Author(s):  
F. I. QURESHI ◽  
R. HORNIGOLD ◽  
J. D. SPENCER ◽  
S. M. HALL
Keyword(s):  
Immune System ◽  
Inflammatory Cytokines ◽  
Epidermal Cell ◽  
Langerhans Cells ◽  
Disease Process ◽  
Inflammatory Cells ◽  
Dupuytren’S Contracture ◽  
Palmar Fascia ◽  
Dupuytren's Contracture

We have examined biopsies of Dupuytren’s contracture palmar fascia, overlying subcutis and skin, and have correlated the distribution of gross macroscopic changes in the hand, mapped pre- and intraoperatively, with light microscopic immunohistochemical findings. We report increased numbers of S100 positive Langerhans cells (an epidermal cell of dendritic lineage) and CD45 positive cells, both in “nodules” and at dermo-epidermal junctions, in the biopsied tissues. This suggests that Langerhans cells migrate from the epidermis into Dupuytren’s contracture tissue, possibly in response to local changes in levels of inflammatory cytokines within the tissue. Our findings, together with other reports of increased numbers of dermal dendrocytes and inflammatory cells in Dupuytren’s contracture tissue, lend circumstantial support to the “extrinsic theory” of the pathogenesis of Dupuytren’s contracture. However, the earliest stages of the disease process have not been defined, and therefore the events which ultimately produce fibrosis in the palmar fascial complex in susceptible individuals could begin in the skin and/or within deeper tissues, especially where there is dysregulation of the immune system.

Boutonniere Deformity in Dupuytren’s Disease

1988 ◽  
Vol 13 (4) ◽  
pp. 379-382
Author(s):  
J. N. KUHLMANN ◽  
A. BOABIGHI ◽  
S. GUERO ◽  
M. MIMOUN ◽  
S. BAUX
Keyword(s):  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Complete Ablation ◽  
Boutonniere Deformity ◽  
Extensor Apparatus ◽  
Boutonnière Deformity

The boutonnière deformity in Dupuytren’s disease has been found to be due to fibrous contraction of the transverse retinacular ligament which anteriorly displaces the fibres of the extensor apparatus. Complete ablation of this ligament and liberation of the extensor apparatus arrows easy extension of the finger when operating on severe cases of Dupuytren’s contracture.

scholarly journals “The Serpentine Zone”: A Surgeon's Guide to the Surface Anatomy of the Digital Neurovascular Spiral in Dupuytren's Contracture

2017 ◽  
Vol 10 (01) ◽  
pp. 054-056
Author(s):  
Alistair Macey ◽  
Roshin Thomas
Keyword(s):  
Neurovascular Bundle ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Surface Anatomy ◽  
Neurovascular Injury

AbstractThe anatomy of the cords that form in Dupuytren's disease is complicated and a spiral cord is the most challenging variant to address. It displaces the neurovascular bundle toward or beyond the midline and closer to the skin. This article illustrates the surface anatomy of the neurovascular spiral to help surgeons identify this zone of danger that the authors term “the serpentine zone.” Careful dissection in this zone will help avoid iatrogenic digital neurovascular injury.

Dupuytren’s Contracture: An Update of Biomolecular Aspects and Therapeutic Perspectives

2005 ◽  
Vol 30 (6) ◽  
pp. 557-562 ◽  
Author(s):  
A. CORDOVA ◽  
M. TRIPOLI ◽  
B. CORRADINO ◽  
P. NAPOLI ◽  
F. MOSCHELLA
Keyword(s):  
Extracellular Matrix ◽  
Surgical Excision ◽  
Dupuytren’S Contracture ◽  
Palmar Fascia ◽  
Dupuytren's Disease ◽  
The Real ◽  
Practical Applications ◽  
Dupuytren's Contracture ◽  
Palmar Fibromatosis

The so-called fibrogenic cytokines, able to induce the growth of fibroblasts and their differentiation into myofibroblasts and to stimulate their production of extracellular matrix, are involved in the genesis of Dupuytren’s contracture. Although many studies have been made of biomolecular aspects of palmar fibromatosis, practical applications from them are still far from imminent because of the real difficulty of blocking their action in vivo, even in a chronic, progressive lesion such as Dupuytren’s disease. Consequently, surgical excision of the palmar fascia still remains the treatment of choice.

scholarly journals Surgical management of Dupuytren contracture of the ring finger: a case report

2020 ◽  
Vol 8 (4) ◽  
pp. 1570
Author(s):  
Gede Ketut Alit Satria Nugraha ◽  
Made Bramantya Karna ◽  
Gde Dedy Andika ◽  
Made Sunaria
Keyword(s):  
Gold Standard ◽  
Ring Finger ◽  
High Rate ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Disease ◽  
Disease Etiology ◽  
Dupuytren's Contracture ◽  
Scar Assessment

Dupuytren’s disease, also called Dupuytren’s contracture or palmar fibromatosis, is a condition in which the connective tissue under the skin of the palm contracts and toughens over time. The gold standard treatment for Dupuytren’s contracture is surgery. We present a case of Dupuytren’s contracture treated with Bruner incision which resulted in good functional outcome. A 79 year old male presented to our Orthopaedic Clinic RSUP Sanglah Denpasar with the complaints of pain and stiffness on his left ring finger since 5 years ago. Patient had same history with his right hand and had operation 20 years ago. The patient underwent release of contracture using Bruner incision and had no complaint in 6 month follow-up. Extension deficit was <5°, reduction of contracture was >50%, the Patient and Observer Scar Assessment Scale (POSAS) gave overall opinion of the scar being minimal. The Dupuytren's disease etiology remains uncertain, with genetics perceived as most probable factor. Despite short-term success, there is a high rate of recurrent contracture with additional comorbidities such as wound-healing complications and neurovascular injury. In this case, the patient was treated using fasciotomy with Bruner incision and had satisfying outcome. Fasciotomy is known to have less complication in terms of recurrence. Dupuytren disease is characterized by abnormal thickening of the palmar fascia beneath the skin and the gold standard of treatment is surgery. This case presented surgical treatment using Bruner incision which had satisfying outcome in 6 month follow-up.

scholarly journals Limited palmar fasciectomy for bilateral Dupuytren’s contracture

2021 ◽  
Vol 9 (10) ◽  
pp. 3186
Author(s):  
Surya Rao Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj ◽  
Narayanamurthy Sundaramurthy ◽  
Anand Prasath Jayachandiran ◽  
Suresh Rajendran
Keyword(s):  
Surgical Treatment ◽  
Dupuytren’S Disease ◽  
Northern Europe ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Dupuytren Disease

Dupuytren’s disease is a fibro-proliferative condition affecting the palmar and digital fascia. This disease is very common in Northern Europe but in India it uncommon as there are only a few cases reported, hence also called as ‘Viking Disease’. Surgical fasciectomy is the standard surgical treatment of choice for Dupuytren’s disease. Complications following surgery are high but there is no definitive cure for Dupuytren disease (DD), and recurrence of finger contractures after treatment is common.

Cost Comparison of Collagenase Clostridium Histolyticum and Fasciectomy for Treatment of Dupuytren’s Contracture in the Australian Health System

2018 ◽  
Vol 23 (03) ◽  
pp. 336-341 ◽  
Author(s):  
Andrew K. Sefton ◽  
Belinda J. Smith ◽  
David A. Stewart
Keyword(s):  
Treatment Options ◽  
Cost Comparison ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Health Care Environment ◽  
Dupuytren's Disease ◽  
Australian Health ◽  
Dupuytren's Contracture ◽  
Clostridium Histolyticum

Background: Dupuytren’s disease results in contracted cords in the hand that lead to deformity and disability. Current treatment options include fasciectomy and an injectable, collagenase clostridium histolyticum. No cost comparison studies have been published within the Australian health care environment. Methods: A retrospective review of all patients treated for Dupuytren’s disease in a major teaching hospital was undertaken to compare the costs of treatment by fasciectomy or collagenase injection. Results: Eighteen patients underwent fasciectomy and 21 collagenase clostridium histolyticum injections were performed during the study period and were eligible for inclusion under the review criteria. Of the 39 patients, 36 were male and 3 were female with an average age 66.4 years (50–85). Twenty-five digits were treated by fasciectomy in 18 patients, and 23 digits were treated by collagenase in 21 patients. The fasciectomy group attended an average 9.2 visits (5–22), incurring an average costing of US$5738.12 per patient ($3181.18–$9618.10). The collagenase group attended an average 3.8 visits (3–8), incurring an average costing of US$2076.83 per patient ($1842.24–$3929.57). Conclusions: Collagenase treatment of Dupuytren’s contracture represents a significant reduction in cost relative to fasciectomy, with 64% savings, length of follow up and number of visits. This is a similar finding to studies in other countries.

The Continuous Elongation Technique for Severe Dupuytren’s Disease

1994 ◽  
Vol 19 (4) ◽  
pp. 522-527 ◽  
Author(s):  
A. J. BAILEY ◽  
J. F. TARLTON ◽  
J. VAN DER STAPPEN ◽  
T. J. SIMS ◽  
A. MESSINA
Keyword(s):  
Tensile Strength ◽  
Enzyme Activity ◽  
Continuous Extension ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Cross Link ◽  
Collagen Fibres ◽  
Dupuytren's Disease ◽  
Dupuytren's Contracture ◽  
Degradative Enzymes

Continuous extension of Dupuytren’s contracture prior to fasciectomy results in a softening of the tissue, allowing straightening of the fingers. The observed change in cross-link profile indicates an increase in newly synthesised collagen due to increased turnover. This was confirmed by demonstration of the increases in levels of the degradative enzymes, the neutral metalloproteinases, collagenase and gelatinase and the acidic cathepsins B and L. Both types of enzyme effectively depolymerize the collagen fibres, albeit by different mechanisms, leading initially to loss of tensile strength and ultimately to solubilization. We suggest that the increase in enzyme activity is generated by tension on the fibroblasts of this metabolically active tissue produced during the continuous extension of the retracted fingers. The weakening of the fibres by degradation and the increase in newly synthezised collagen provide an explanation for the extension of the tissue without trauma.

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