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Title:

Dupuytrens Disease

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Normal Fascia. 95% Type I collagen. 5% Type III collagen ... Pathologic change in normal fascia. Bands Cords. Myofibroblast produce contractile behavior ... – PowerPoint PPT presentation

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Title: Dupuytrens Disease


1
Dupuytrens Disease
  • Chris Bainbridge

2
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3
History
  • Plater 1614
  • Cline 1808
  • Cooper 1822
  • Dupuytren 1831

4
Basic Science
Fibroblasts Myofibroblasts Not Unique
5
Basic Science
  • Normal Fascia
  • 95 Type I collagen
  • 5 Type III collagen
  • Dupuytrens Fascia
  • 40 Type III collagen

6
Basic Science
  • Local ischemia leads to fibroblast proliferation
  • Myofibroblasts
  • responsive to growth
  • factors

7
Normal Anatomy
  • Palmar Aponeurosis
  • Septi of Legueu and
  • Juvara
  • Superficial Transverse
  • Palmar Ligament
  • Pretendinous Band

8
Normal Anatomy
  • Spiral Band
  • Natatory Ligament
  • Lateral Digital Sheath
  • Clelands Ligament
  • Graysons Ligament
  • Retrovascular Band
  • Neurovascular Bundle

9
Pathoanatomy
  • Pathologic change in normal fascia
  • Bands Cords
  • Myofibroblast produce contractile behavior

10
  • MP contracture
  • Pretendinous Cord
  • Thumb web
  • Palmar Aponeurosis
  • Web space
  • Natatory Cord

11
PIP joint
  • Lateral Digital Cord
  • Graysons Ligament
  • Central Cord
  • Spiral Cord
  • Retrovascular Cord

12
DIP Joint
  • Lateral Digital Cord
  • Retrovascular Cord

13
Demographics
  • Viking heritage
  • Genetics
  • Complex
  • Multifactorial
  • Mitochondrial element
  • Particular loci now identified

14
Clinical History
  • Age
  • 40 to 60 years (can start younger)
  • MaleFemale is 71
  • Pathognomonic
  • Nodule
  • Often tender
  • Usually at base of ring finger

15
Clinical examination
  • Flexion Contractures
  • MP, PIP
  • Bilateral
  • Ectopic Deposits

16
Associated Disease
  • Smoking
  • Alcohol
  • Diabetes
  • Epilepsy

17
Trauma
  • NOT related to manual work
  • MAY appear after a single episode of trauma

18
  • Family History
  • Early Onset
  • Bilateral - Radial
  • Ectopic Deposits

19
Operative Indications
  • Table Top Test
  • MP gt 30 degrees
  • PIP - any contracture

20
Surgical approaches
  • Fasciotomy percutaneous needle
  • Segmental Fasciectomy
  • Fasciectomy
  • Radical Fasciectomy

21
Percutaneous needle Fasciotomy
  • This has been a routine technique in my hands for
    many years.
  • Mainly for Palmar disease affecting MP joint
  • Good short term outcome
  • High complication rate distal to MP joint.

22
Incisions
  • Brunner (zig-zag)
  • Skoog (straight line with Z-plasty)
  • Zig-zag with V-Y extension

23
Wound closure
  • Direct closure with Z-plasty
  • Open palm technique
  • Skin graft

24
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25
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26
Outcomes
  • MP correction maintained
  • PIP recurrence frequent
  • Loss of flexion

27
Recurrent Disease
  • 26 to 80
  • Nodule - No treatment
  • Dermofasciectomy with FTG
  • High risk of
  • Nerve damage
  • Cold intolerance
  • Stiffness
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