scholarly journals Perforator Flap Based Technique for the Treatment of Dupuytren's Contracture

2019 ◽  
Author(s):  
Tokai B Cooper ◽  
Bin Zhao ◽  
Xinglong Chen ◽  
Zhijie Li ◽  
Weiyang Gao ◽  
...  
Keyword(s):  
Skin Necrosis ◽  
Perforator Flap ◽  
Joint Involvement ◽  
Dupuytren’S Contracture ◽  
Palmar Fascia ◽  
Palmar Arch ◽  
Dupuytren's Contracture ◽  
Distal Interphalangeal ◽  
Hypothenar Eminence

Abstract Background: Perforator flap based technique was used in treating Dupuytren’s Contracture in a cohort of 48 patients. This perforator based on the ulnar palmar digital artery originates from the superficial palmar arch and supplies the hypothenar area. Methods: A curved incision that exposes the diseased palmar fascia was made in middle to distal palm lateral to the hypothenar eminence beginning 20mm distal to the distal wrist crease up to the heel of the palm. An additional incision from the arch of the curved incision extends into the middle phalanx for exposure of the digital cord. The perforator flap was raised along the hypothenar region in 53 hands of 48 patients, nine females and 39 males and their ages at the time of surgery averaged 56 years. The Tubiana classification illustrates the extent of the disease in our patients’ population with no distal interphalangeal joint involvement. Results: Of the 48 patients, five patients had bilateral hands involvement. Two patients complained of paresthesia in the ring and little fingers after surgery, the symptom had disappeared without further intervention before the latest follow-up. There was no incidence of skin necrosis and delayed healing. Up to date, there has been no reported recurrence. Conclusion: This perforator flap based technique is technically simple and reliable with better exposure and easier removal of all the diseased fascia, making it possible for primary healing without skin necrosis and acceptable for treatment of patients at all stages of the disease.

Dupuytren's Contracture and Microvessels

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.

Long term follow-up of dermofasciectomy for Dupuytren's contracture

1994 ◽  
Vol 47 (6) ◽  
pp. 440-443 ◽  
Author(s):  
T.M. Brotherston ◽  
C. Balakrishnan ◽  
R.H. Milner ◽  
H.G. Brown
Keyword(s):  
Dupuytren’S Contracture ◽  
Dupuytren's Contracture ◽  
Long Term Follow Up

The Palmar Fascia after Treatment by the Continuous Extension Technique for Dupuytren’s Contracture

1994 ◽  
Vol 19 (4) ◽  
pp. 528-533 ◽  
Author(s):  
G. BRANDES ◽  
A. MESSINA ◽  
E. REALE
Keyword(s):  
Clinical Stage ◽  
Light And Electron Microscopy ◽  
Continuous Extension ◽  
Collagen Fibrils ◽  
Dupuytren’S Contracture ◽  
Palmar Fascia ◽  
Biosynthetic Activity ◽  
Dupuytren's Contracture ◽  
Uniform Diameter ◽  
External Forces

After complete elongation using the continuous extension technique the palmar fascia of four patients with Dupuytren’s contracture was examined by light and electron microscopy and compared with non-elongated samples from 20 patients at the same clinical stage of the disease. Nodules and cords were no longer clinically recognizable after extension. The tissue contained collagen fibrils of uniform diameter (about 50 nm), densely packed in fibres parallel to the stretching force. Fine filaments (presumably proteoglycans) formed a network which was intermingled with and periodically bound to the collagen fibrils. Fibroblasts and myofibroblasts with an high biosynthetic activity and oxytalan-like microfibrils were aligned along the collagen fibres. The results show that in Dupuytren’s disease the contracted palmar fascia reacts to external forces with neoformation and reorientation of all tissue components by myofibroblasts.

Anatomical Study of the Palmar Intermetacarpal Perforator Flap

2009 ◽  
Vol 34 (2) ◽  
pp. 224-226 ◽  
Author(s):  
P. PELISSIER ◽  
H. GARDET ◽  
E. SAWAYA ◽  
V. PINSOLLE ◽  
V. CASOLI
Keyword(s):  
Perforator Flap ◽  
Anatomical Study ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Contracture ◽  
Skin Cover

The authors present an anatomical study of a small flap that may be harvested from any of the palmar intermetacarpal spaces while performing fasciectomy in Dupuytren’s contracture. The flap is diamond-shaped, vascularised by two perforating branches originating from the underlying true digital arteries and may be rotated through 90° to 180° in either direction to provide skin cover and subcutaneous padding over the distal palm and/or the base of the finger.

scholarly journals The efficacies and limitations of fasciectomy and collagenase clostridium histolyticum in Dupuytren’s contracture management: A meta-analysis

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092174 ◽  
Author(s):  
Tokai B Cooper ◽  
Keshav Poonit ◽  
Chenglun Yao ◽  
Zeyuan Jin ◽  
Jingwei Zheng ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Treatment Algorithm ◽  
Cochrane Library ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Dupuytren's Contracture ◽  
Clostridium Histolyticum ◽  
Palmar Aponeurosis ◽  
The Mean

Background: We intend to assess the efficacies and limitations of collagenase clostridium histolyticum (CCH) and fasciectomy in treating Dupuytren’s contracture, and the associated complications and rate of recurrences aiming to present a treatment algorithm. Methods: A literature search within the PubMed, Web of Sciences, Cochrane Library, and EMBASE databases was performed using the combined key words ‘Dupuytren, palmar aponeurosis contracture, collagenase clostridium histolyticum and fasciectomy’, including all possible studies with a set of predefined inclusion and exclusion criteria. Results: Thirty studies were assessed for eligibility from 215 identified records. Seventeen publications satisfied the inclusion criteria including 2142 joints in 1784 patients. The mean follow-up time was 18.0 months (3–60). Conclusion: Acceptable contractures release was obtained in both techniques. Severe complications associated with fasciectomy outrank those of CCH, whereas the low rate of recurrence favors the fasciectomy technique.

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.

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.

scholarly journals Dynamic Manugraphy as a Promising Tool to Assess the Outcome of Limited Aponeurectomy in Patients With Dupuytren's Contracture

2021 ◽  
Vol 7 ◽  
Author(s):  
Angelina Garkisch ◽  
Thomas Mittlmeier ◽  
Axel Kalpen ◽  
Marion Mühldorfer-Fodor ◽  
Dagmar-C. Fischer ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Grip Force ◽  
Flexion Contracture ◽  
Dupuytren’S Contracture ◽  
Base Line ◽  
Dash Score ◽  
Force Transmission ◽  
Additional Tool ◽  
Dupuytren's Contracture

Background: Dupuytren's contractures interfere with physiological gripping. While limited aponeurectomy is an accepted treatment modality to restore finger mobility, methods to objectify functional outcome beyond determination of the range of motion are scarce.Methods: Patients with Dupuytren's contracture being scheduled for unilateral limited aponeurectomy were invited to participate. Clinical data were gathered prospectively by chart review and interview. The DASH-score and flexion contracture for fingers were registered prior to surgery, 3 and 6 months afterwards. At the same time, dynamic manugraphy for simultaneous recording of the grip pattern and forces generated by the affected hand and anatomic areas (i.e., thumb, index finger, middle finger, ring finger, little finger and palm) were performed. All findings obtained during the follow-up period were compared to the situation at baseline. Comparison between paired samples was done using Wilcoxon rank test. All p-values are two-sided and p < 0.05 was considered to be significant.Results: Out of 23 consecutively enrolled patients, 19 (15 men, 4 women) completed follow-up examinations. Manugraphy confirmed the impairment of physiological gripping with concomitant pathological load distribution at base line. Limited aponeurectomy significantly reduced flexion contractures. However, the DASH-score remained at an excellent level in one patient, indicated improvement in 11 and worsening in seven patients. Six patients had lower grip force at t6 compared to the preoperative condition, although the preoperative flexion contracture (≥110°) was considerably improved in all of them. In four of those, the DASH-score improved while it turned worse in two of them. The force of surgically treated fingers remained unchanged in three patients while it was improved and worsened in half of the remaining patients, respectively. Manugraphy revealed physiological gripping by enlargement of contact area and higher force transmission by the fingertips in 10 of 12 patients with constant or even improved DASH-score and in three of seven patients with a worsened DASH-score.Conclusions: Assessing the reduction of flexion contracture and grip force alone is not sufficient to comprehensively reflect the functional outcome of aponeurectomy for Dupuytren's disease. Visualizing physiological grip pattern provides an additional tool to objectify the success of surgical treatment.

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