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PubMed1984

Dupuytren's contracture: a comparative study of fasciectomy and dermofasciectomy in one hundred patients.

This study reviews one hundred patients with Dupuytren's disease treated surgically by the Derby Hand Unit between January 1975 and September 1981. One hundred and twenty-eight operations were assessed with a follow-up period from nine months to ninety months, average thirty-eight months. In thirty-five patients the overlying skin was excised and replaced by a full-thickness skin graft (dermofasciectomy). The remaining patients were treated by fasciectomy without skin excision. The overall recurrence rate after surgery was found to be 46.5%. However skin excision and replacement following fasciectomy prevented any appreciable, if not all recurrence of Dupuytren's tissue. The function of the hand was assessed with regard to the improvement in flexion contracture; ability to flex the finger to the distal palmar crease; sensibility of the replaced skin; time to return to work and full activity. It was concluded that skin replacement did not jeopardize hand function.

Aged↗
PubMed1984

[An unusual post-traumatic contracture of the hand--2 cases].

Extreme flexor tendon contractures following blunt injury are seldom described. Unsatisfactory final results after such an injury in the hand and wrist regions in two young female patients with mental defect are described. All conservative methods of treatment were useless and extensive MP- and PIP-arthrodeses were necessary.

Adolescent↗
PubMedDate not supplied

Management of forearm pronator teres contractures.

The authors report the results of their management of 14 forearm pronator teres contractures resulting from cerebral palsy. In almost every case, treatment was started with orthopedic splints and physiotherapy followed by the Gosset-Scaglietti technique and, one year later, Stoffel surgery, as proposed by Bastos-Mora in order to denervate the hypertonic pronator teres, was performed. The results were good in 80% of cases, fair in 16% and poor in 4%.

Adolescent↗
PubMed1983

Measurement of contractures of the digits in systemic sclerosis. Development of digit-goniometers and definitions of normal joint motility of the digits of elderly persons.

New goniometers were constructed for the measurement of joint motility in the proximal interphalangeal (PIP) and metacarpophalangeal (MP) joints of the digits. 25 patients with systemic sclerosis (mean age 60 years, range 32-83) were studied, and compared with 25 healthy controls, matched for sex and age (mean age 58 years, range 29-87). The flexion, extension and entire joint motility of the PIP and MP joints were significantly decreased. From the measurements in the controls, standards for normal joint motility were defined (mean +/- 1 to 2 SD): PIP joint flexion 110 degrees, extension 5 degrees, entire motility 130 degrees; MP joint flexion 90 degrees, extension 20 degrees, entire motility 110 degrees. Joint motility was not correlated to sex and age in these elderly controls. The entire joint motility was reduced in the PIP joint in 19 (76%) patients, and in the MP joint in 17 (68%) patients with systemic sclerosis according to the standards. This corresponded well with the clinical assessment of contracture.

Adult↗
PubMed1983

Selective aponeurectomy by Skoog's method in the treatment of Dupuytren's contracture.

Whatever surgical procedure is adopted in Dupuytren's contracture, it demands the utmost finesse and delicacy of technique. Even so, the functional and cosmetic results are often equivocal, but in our view Skoog's technique offers the most practical and effective method of treatment. It offers the following advantages: Duration of operation: In a case of moderate severity affecting only 2 digits the operation can be completed in 30-40 minutes. The surgical trauma is minimal and post-operative complications are therefore minimal. Recovery of function is rapid and there is complete absence of the disturbances associated with prolonged immobilisation. The relapse rate is minimal and certainly no greater than that associated with more radical techniques. The only disadvantage, if it can be so considered, is that the surgeon must be perfectly familiar with the detailed anatomy of the palm and fingers. Since the method does not involve the more extensive exposure and display of all the structures, as in other methods, it is easier in the absence of such knowledge to do accidental damage.

Dupuytren Contracture↗
PubMed1983

[Sporadic occurrence of benign myopathy with early contractures (Emery, Dreifuss and Rotthauwe)].

A myopathy which sporadically appeared in a young male corresponds clinically, electromyographically, histologically and cardiologically to the rare picture of the X-chromosomally recessive benign myopathy with early contractures. The coordination to the clinical picture mentioned and the genetic advice, taking into consideration the X-chromosomally recessive heredity, are discussed and proved.

Adult↗
PubMed1980

[The treatment of Dupuytren's contracture. A social medical problem (author's transl)].

After a brief description of the characteristics of Dupuytren's disease the operative and conservative therapeutic measures are examined from both clinical and social medical aspects. It is shown in 154 patients with Dupuytren's contracture of the hands in various stages that an advance of this disease could usually be prevented by treatment with soft X-rays. A comparison of costs shows that this therapy is at least 11 times cheaper than a good operative procedure without follow-up treatment. For the patient it is highly important that only little time is lost in the outpatient compared with inpatient treatment. Loss of work-place, professional incapacity or inability to work because of Dupuytren's disease can be prevented with a probability bordering on certainty.

Disability Evaluation↗
PubMed1982

Tarso-septal Z-plasty combined with skin grafting for the late correction of traumatic upper lid contractures.

A technique for the repair of upper eyelid contracture, which involves a full thickness "tarso-septal Z plasty," is described. The vertical arm goes through the scarred area, and the horizontal arms are approximately parallel to the brow and eyelid margin. Skin grafting is also commonly done in conjunction, and the operated lid is then kept in overextension for two to four weeks.

Contracture↗
PubMed1978

Fibrous muscular contractures: treatment with a new direct contact microwave applicator operating at 915 MHz.

A patient having bilateral contractures of the rectus femoris and brachial biceps muscles due to pentazocine injection was treated with a regime of heat and stretch. Heat was provided by a new air cooled direct contact applicator operating at 915 MHz. Stretch was applied by adding weights to a cable which was attached to the arm or leg to be stretched. While the left and right elbows which were limited by the contracted biceps were not stretched sufficiently to achieve a normal range of motion, the rectus femoris muscle on both sides did achieve a normal range of motion.

Contracture↗
PubMed1980

Possible role of myofibroblasts in the pathogenesis of Dupuytren's contracture.

In the contracting palmar aponeurosis of patients suffering from Dupuytren's disease myofibroblasts are revealed by electron microscopical examination. These cells display abnormal foldings of the nucleus, microfilaments resembling the myofilaments in smooth muscle cells, rough endoplasmic reticulum occupying circumscribed portions of the cytoplasm, free ribosomes, well-developed Golgi apparatus, numerous mitochondria, occasionally lipid droplets, cilia-like formations, hemidesmosomes and maculae adherens (desmosomes) between the cells and formation of basement membrane. According to literary data, the myofibroblasts contain actin and have contractile properties. These myofibroblasts are supposed to contribute to the development of Dupuytren's contracture. The process is finally stabilized by the disappearance of myofibroblasts and by the simultaneous development of compact collagenous fibre bundles secernated by classical fibroblasts.

Cytoskeleton↗
PubMed1980

[The role of myofibroblasts in the pathogenesis of Dupuytren's contracture].

The involved palmar aponeurosis of 30 patients in different stages of Dupuytren's disease was removed and examined by light and electron microscopy. The specimens were obtained by Z-plasty and limited fasciectomy. The light microscopic slides of the early stages of the disease showed areas rich in cells and surrounded by a network of collagen fibres. In the late phase of the lesion mature scar tissue was observed. By electron microscopy fibroblast-like cells--so-called myofibroblasts were seen in the early stages of the lesion. These cells possess, in addition to nuclear deformations, the following ultrastructural cytoplasmic characteristics: microfibrils occasionally forming small dense bodies, prominent rough endoplasmic reticulum and Golgi complex, many mitochondria and free ribosomes. The cell surface if partly covered by a "basement membrane". The myofibroblasts attach to each other frequently through hemidesmosomes or desmosomes. According to data in the literature, the microfilaments within the cytoplasm contain actin, consequently these cells have the property of contraction. In our opinion--in accordance with some other authors--the myofibroblasts might play an important role in the pathogenesis of Dupuytren's contracture.

Cicatrix↗
PubMed1980

Dupuytren's contracture: clinical and therapeutic aspects.

The writers first describe the main features of the pathological anatomy and clinical characteristics of Dupuytren's contracture. They classify the lesions by Tubiana's method, which is eminently objective and practical. This classification divides the lesions, according to their severity, in five stages: 0, 1, 2, 3, 4. The surgical technique of total aponeurectomy used by the authors is described. The total case material is thirty patients, with thirty-three hands operated on. By comparing the state of the hand before and after operation, the degree of improvement was calculated as a percentage derived from Tubiana's method of classification. A careful evaluation of the results confirms the validity of the therapeutic approach adopted. The indications and prognosis depend on the severity of the initial lesions. In general the chances of cure are good up to stage 3; but once this stage has been passed, and especially if hyperextension of the terminal phalanx is present, there is a high probability of recurrence and failure. In these cases they advise against corrective surgery and consider arthrodesis or amputation a more suitable alternative.

Accidents, Occupational↗
PubMed1981

Treatment of pronation contractures of the forearm in cerebral palsy by changing the insertion of the pronator radii teres.

In twenty-two patients with cerebral palsy and a pronation contracture of the forearm, transfer of the pronator radii teres posteriorly to the anterolateral border of the radius converted it from a pronator to a supinator. Of the twenty-two patients so treated and followed for two to six years, 82 per cent were judged to have a good to excellent result since they had gained an average of 46 degrees of active supination compared with their preoperative status. There was no loss of motion with the passage of time and, determined by palpation, active contract of the transferred pronator teres was evident during voluntary supination. The procedure allowed the patients to improve function significantly by giving them the ability to supinate the forearm during activities requiring axial rotation of the forearm.

Adolescent↗
PubMed1980

[The treatment of Dupuytren's contracture from the medical gymnastic standpoint].

A special treatment program has been developed for each individual patient. Each day the patient receives three different treatment modalities--active exercises, passive exercises and electrical stimulation. On days when X-ray therapy is administered, the patient performs only active exercises and receives no electrical stimulation. The patient is also directed to perform certain exercises at home. Patients are advised strongly against the use of hot baths. Dynamic splints are adjusted regularly. In winter and during cold weather, patients are instructed to wear gloves. This therapy, combined with meticulous surgical technique, permits the rehabilitation of most hands affected by Dupuytren's contracture. The goal of rehabilitation is tailored to the needs of the patient and should include a sufficiently strong grasp, chuck pinch and possibly a good pulp pinch. When necessary, the therapy should be continued for long periods of time because a small gain in mobility may represent a significant improvement in overall function of the hand.

Dupuytren Contracture↗
PubMed1981

Dupuytren's contracture: the deferred Z-plasty.

The technique of dissecting Dupuytren's contracture through a straight incision placed along the contracting band and deferring Z-plasty to be performed as a secondary procedure is safe, simple, and short and allows maximum skin viability and earliest mobilisation.

Dupuytren Contracture↗
PubMed1980

Dupuytren's contracture. An electron microscopic, biochemical, and clinical correlative study.

Fascial specimens were obtained from twenty-four patients treated operatively for Dupuytren's contracture. The nodules and cords were examined by electron microscopic and biochemical techniques. The clinical course and response to operative treatment were then correlated with the tissue findings. Electron microscopic analysis revealed myofibroblasts in the nodules of seven of twenty-four patients. Fibroblasts containing prominent microtubules were found in ten patients. The fascia contained type-III collagen, increased amounts of collagen per unit of dry weight, and an increase in reducible cross-links of collagen. While the nodules were noted to contain a greater increase in reducible cross-links than the cords, there was little variation in the biochemical findings from patient to patient. Clinical recurrence was not related to the age of the patient at onset, duration, or severity of disease. Recurrence was related to the electron microscopic findings of myofibroblasts in the nodules and fibroblasts containing prominent microtubules in the fascia of these patients.

Aged↗
PubMed1980

The role of the myofibroblast in Dupuytren's contracture.

A case report of Dupuytren's contracture illustrates the functional and light and electron microscopic characteristics of the myofibroblast. The myofibroblast is now associated with an increasing number of diseases, and is believed to be a morphologic and functional variant of the fibroblast, which shows changes typical of smooth-muscle cells. Its presence may be suspected by light microscopy, but its ultrastructure is characteristic. Its distinctive electron microscopic features are a fibrillar system in the cytoplasm similar to that of a smooth muscle, nuclear deformations indicative of contraction, and surface membrane differentiations that provide attachment to neighboring cells and stroma.

Aged↗