Assessment of palmar subcutaneous tissue vascularization in patients with Dupuytren’s contracture

Abstract

AIMTo investigate the structural and functional characteristics of palmar hypodermal tissue vascularization in Dupuytren’s contracture patients of different age groups.METHODSEighty-seven Dupuytren’s contracture patients underwent partial fasciectomy. Twenty-two of them were less than 55 years old (Y-group, n = 22); the others were 55 and older (O-group, n = 65). In surgically excised representative tissue samples, a histomorphometric analysis of the perforating arteries of the palmar aponeurosis and stereologic analysis of hypodermis vascularity were performed. The method of laser flowmetry estimated the microcirculation of the skin of the palm.RESULTSFrequency of cases with rapid development of contracture (less than 5 years) was 13.6% in the Y-group and 40% in the O-group, P < 0.05. The external and luminal diameters of perforating arteries in palmar fascia were decreased more severely in Y. The thickness of intima increased three times compared with healthy control, and the intima/media relation also increased, especially in O. Increased numerical and volumetric micro-vessel densities in hypodermis, percentage of large vessels (more than 12 μm in diameter), and percentage of vessels with signs of periadventitial inflammatory infiltration were noted in Y. The percentage of vessels with adventitial fibrosis was greater in O than in Y. Base capillary flow in Y was increased compared to healthy control subjects and to O, and peak capillary flow was increased in comparison with control.CONCLUSIONCompared to the O-group, Y-group patients exhibited more severe constrictive remodeling of palmar fascia perforating arteries supplying hypodermis but more expressed compensatory changes of its capillarization.

The Role of IL-6 in Skin Fibrosis and Cutaneous Wound Healing

“…The number of macrophages in the disease tissue is correlated with the presence of myofibroblasts [83], which are indicative of active disease. As with other fibrotic conditions, the growths show increased vascularization [57]. The pro-survival, pro-proliferative signaling of IL-6 and its downstream effector cytokines likely contribute to the microenvironment conducive to angiogenesis.…”

“…Vascularization is an important component of wound healing, and impaired vascularization delays wound closure [55]. However, the dysregulation of vascularization, potentially through the expression VEGF, may be a component of fibrotic disease pathogenesis, as many fibrotic diseases, much like proliferative neoplasms, feature increased vascularization [56,57].…”

Biochemical and Histological Differences between Longitudinal and Vertical Fibres of Dupuytren’s Palmar Aponeurosis and Innovative Clinical Implications

“…No studies relating to vascularization in pathological longitudinal and vertical septa have been published in the literature. Shchudlo and coauthors (2018) investigated the structural and functional characteristics of palmar hypodermal tissue vascularization in Dupuytren's diseased patients of different age groups, demonstrating that the younger group exhibited more severe constrictive remodelling of the palmar fascia in perforating the arteries supplying the hypodermis compared with the older patients, with more compensatory changes of its capillarization [16]. Holzer and coauthors (2013) demonstrated a higher expression of HIF-1α (hypoxia-inducible factor alfa) and VEGFR2 (vascular endothelial growth factor receptor 2), statistically significant compared to the controls, in the Dupuytren's diseased tissue of palmar aponeurosis: the subsequent hypoxic conditions and angiogenesis are fundamental stimulators of fibrosis, indicating their participation in the myofibroblast-rich nodules as active disease processes [17].…”

Tardigrade and Manifold Sign: Two New Signs in Dupuytren's Disease

“…The disease mostly affects men > 40 years of age. 4,5 Heavy alcohol consumption, smoking, and exposure to manual work showed a positive dose-response relationship with the prevalence of DD. 5,6 The pathogenesis involves abnormal myofibroblastic growth in the fasciae of the hand.…”