Dupuytrens Disease

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Dupuytrens Disease

• Chris Bainbridge

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History

• Plater 1614
• Cline 1808
• Cooper 1822
• Dupuytren 1831

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Basic Science
Fibroblasts Myofibroblasts Not Unique
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Basic Science

• Normal Fascia
• 95 Type I collagen
• 5 Type III collagen
• Dupuytrens Fascia
• 40 Type III collagen

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Basic Science

• Local ischemia leads to fibroblast proliferation
• Myofibroblasts
• responsive to growth
• factors

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Normal Anatomy

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

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Normal Anatomy

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

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Pathoanatomy

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

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

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PIP joint

• Lateral Digital Cord
• Graysons Ligament
• Central Cord

• Spiral Cord
• Retrovascular Cord

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DIP Joint

• Lateral Digital Cord
• Retrovascular Cord

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Demographics

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

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Clinical History

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

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Clinical examination

• Flexion Contractures
• MP, PIP
• Bilateral
• Ectopic Deposits

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Associated Disease

• Smoking
• Alcohol
• Diabetes
• Epilepsy

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Trauma

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

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

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Operative Indications

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

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Surgical approaches

• Fasciotomy percutaneous needle
• Segmental Fasciectomy
• Fasciectomy
• Radical Fasciectomy

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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.

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Incisions

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

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Wound closure

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

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Outcomes

• MP correction maintained
• PIP recurrence frequent
• Loss of flexion

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Recurrent Disease

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