Avoidance of recurrence of CRPS Type 1 in individuals requiring further surgery for Dupuytren's contracture

Aim– to investigate the patterns of cutaneous microcirculation and their relationship with structural vascular changes in palmar hypoderm in patients with Dupuytren’s disease.Material and methods. In 26 patients with Dupuytren’s contracture aged between 45 and 70 years, the microcirculation of palmar skin was assessed before the planned surgical treatment using ultrasound pulsed Doppler (Minimax-Doppler K, SP Minimax, St. Petersburg, Russia) with a high-frequency sensor of 20 MHz and laser Doppler flowmetry (BLF21, Transonic Systems Inc., USA). The local 3-minute arterial ischemic test was performed in all patients by putting the occlusion cuff on the forearm. Histological analysis of intra-operative tissue specimens was done using light microscopy (Carl Zeiss Primo Star microscope with 3.1 MP UCMOS video camera) MicroCapture Ver 6.6 program was used for data acquisition.Results. The normocirculatory type of hemodynamics (1) was found in 17 % of observations; hyperemic (2) – in 19 %, congestive-spastic (3) – in 42 %, and congestive-static (4) – in 21 %. Histologically type 1 was characterized with initial signs of constrictive arterial remodeling and capillary occlusion, 2 – with marked hyperemia of the microcirculatory bed and diapedesis of blood cells, inflammatory perivascular infiltrates, 3 – with significant narrowing and deformations of lumens in small arteries and hyalinosis of arterioles, 4 – with pronounced polymorphism of capillary loops, significant changes in arteries and veins.Discussion. Hyperemic type of microcirculation reflects high activity of autoimmune inflammation. Congestic-spastic type indicates a significant decrease in the reactivity of precapillary microvessels. Congestic-stasic type is accompanied by the most pronounced constrictive vascular remodeling and denervation of the vascular bed.Conclusion. Dupuytren’s contracture is characterized with predominance of pathological types of microcirculation in palmar skin, which must be taken into account in individualized protocols of additive therapy.

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Dupuytren's Contracture and Microvessels

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100098848 ◽

1981 ◽

Vol 39 ◽

pp. 470-471

Author(s):

C. W. Klscher ◽

D. Speer

Keyword(s):

Hypertrophic Scar ◽

Active Form ◽

Scar Tissue ◽

Vascular Supply ◽

Fiber Bundles ◽

Dupuytren’S Contracture ◽

Palmar Fascia ◽

Immune Disease ◽

Dupuytren's Contracture ◽

Longitudinal Fiber

Dupuytren's Contracture is a nodular proliferation of the longitudinal fiber bundles of palmar fascia with its attendant contraction. The factors attributed to its etiology have included trauma, diabetes, alcoholism, arthritis, and auto-immune disease. The tissue has been observed by electron microscopy and found to contain myofibroblasts.Dupuytren's Contracture constitutes a scar, and as such, excessive collagen can be observed, along with an active form of fibroblast.Previous studies of the hypertrophic scar have led us to propose that integral in the initiation and sustenance of scar tissue is a profusion of microvascular regeneration, much of which becomes and remains occluded producing a hypoxia which stimulates fibroblast synthesis. Thus, when considering a study of Dupuytren's Contracture, we predicted finding occluded microvessels at or near the fascial scarring focus.Three cases of Dupuytren's Contracture yielded similar specimens, which were fixed in Karnovskys fluid for 2 to 20 days. Upon removal of the contracture bands care was taken to include the contiguous fatty and areolar tissue which contain the vascular supply and to identify the junctional area between old and new fascia.

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