[Dupuytren contracture: new aspects on form pathogenesis and surgical principle].
More than 20 years ago, the author formulated the proposition "extension inhibition instead of contraction" to explain the pathogenesis of Dupuytren's disease. This concept and the limited surgery derived from it are presented with preliminary long-term results. The tissue dynamics at the palmodigital zone were investigated. Subcutaneous microdissection and the first slices of adult hands (plastination) served to investigate the intact skin-covered subcutaneous tissue layer. On the flexor side, the hand has a complex skin anchoring system which effects mobile attachment of the digital subcutaneous tissue and stationary attachment of the palmar subcutaneous tissue. The disease fixes the flexion position of the tissue layer and impedes extension of the subcutaneous tissue and fingers. It is not the open but the closed hand from which fibromatosis starts. The principle "retention of flexion position" does not imply a contraction mechanism. The pathological substrate undergoes tendinous straightening by traction. There is secondary hypertrophy of the longitudinal fascicles of aponeurosis. The derived principle of limited surgery leaves the aponeurosis in situ. The preliminary results of follow-up examinations after five years and more show that there is no increased danger of recurrence when the aponeurosis is not removed. Out of 72 hands, 34 (47%) proved to be free of disease. Recurrences were found in 17 (24%) hands.
Meinel
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Abteilung für Chirurgie und Unfallchirurgie, Kreiskrankenhaus Tauberbischofsheim.
D000328:Adult; D002455:Cell Division / Q000502:physiology; D003238:Connective Tissue / Q000473:pathology / Q000601:surgery; D062109:Dermatologic Surgical Procedures; D004387:Dupuytren Contracture / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006225:Hand / Q000473:pathology / Q000601:surgery; D006801:Humans; D006984:Hypertrophy; D008866:Microsurgery / Q000379:methods; D009119:Muscle Contraction / Q000502:physiology; D012008:Recurrence; D012867:Skin / Q000473:pathology; D013710:Tendons / Q000473:pathology / Q000601:surgery