PubMed · 14124642
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H EHLERS, L ZACHARIAE. 1964. MENTALITY AND DYSTROPHY.. https://doi.org/10.3109/17453676408989308
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Dupuytren's contracture is a common disease affecting the palmar fascia. It is mostly found in the elderly population, although more aggressive cases are not uncommon in the younger population. After a historic and epidemiological review, the clinical picture, histology and pathogenesis, the surgical treatment, and the latest therapeutic options are presented.
Dupuytren's contracture is a disease caused by the proliferation of contractile, fibroblastic cells adjacent to the palmar fascia of the hand. Cellular proliferation is apparently related to similar 'fibroblast' proliferation in wound healing, but continues in the absence of wounding. I propose that this is a similar processes to that which happens in the vascular wall during vascular surgery, that the myofibroblasts are at least partially similar to smooth muscle cells in phenotype, and consequently that treatment with VEGF, either as protein or via gene therapy, which has proven successful in controlling aberrant, wounding-related cell proliferation in arterial grafting, may be valuable in preventing recurrence of Dupuytren's disease after surgery.
The clinical distribution of the Dupuytren's disease cords in the thumb and first web was examined in 100 consecutive patients with Dupuytren's disease. The precise anatomical relations of the cords were then studied in 25 patients undergoing Dupuytren's surgery for thumb and first web space disease. Thumb and first web space involvement was found in 28% of hands affected by Dupuytren's disease, and was the third most common site after the ring and little fingers. Operative findings showed that two major cords could be distinguished. One lying in the first web space and passing towards the insertion of the first dorsal interosseous muscle on the radial side of the index finger and the other lying on the radial aspect of the thumb.