Comparison of palmar aponeuroses from individuals with diabetes Mellitus and Dupuytren's contracture

Abstract

It is well known that Dupuytren's contracture is often associated with diabetes mellitus. Palmar fascia from individuals with diabetes mellitus and/or Dupuytren's contracture as well as controls were subjected to differential scanning calorimetry, biomechanical and biochemical analysis. The collagen denaturation temperature of the palmar aponeurosis from individuals with diabetes mellitus in the presence (71.0 degrees C) or absence of Dupuytren's contracture (70. 6 degrees C) was increased as compared with controls (68.5 degrees C), while this parameter was significantly reduced (about 3.5 degrees C) in contracture bands of Dupuytren's contracture. Stress relaxation experiments revealed that the viscous fraction was slightly reduced in diabetes mellitus (6.5%) vs. controls (8.3%), whereas in Dupuytren's contracture, irrespective of additional diabetes mellitus, a pronounced increase of this parameter was seen (36.5% vs. 24.5%) in the presence of diabetes mellitus. The time constants were significantly elevated by both disorders, this increase being more pronounced in Dupuytren's contracture. Taken together, these changes can be explained by increased cross-linking in diabetes mellitus, while in Dupuytren's contracture other structural changes, such as increased collagen type III content and loss of fascicular organization, play an additional role besides the finding of reduced cross linking.

Ultrasonography of plantar soft tissues thickness in young people with diabetes

“…Melling et al . [27] found a marked thickening of the palmar aponeurosis of adult diabetic subjects when compared with non-diabetic controls but the viscoelastic properties of this tissue were not significantly different. The palmar and plantar aponeurosis are analogous tissues and are anatomically similar, so it may be supposed that they will respond in the The results are given as mean (± SD) or median (interquartile range).…”

The fascia of the limbs and back – a review

“…As in tendons and ligaments, the predominant collagen is type I (Brickley-Parsons et al 1981). Type III collagen is virtually absent in normal palmar fascia, but accumulates in patients with Dupuytren's disease (Brickley-Parsons et al 1981;Melling et al 1999). Murrell et al (1991) suggest that this may be related to the high density of fibroblasts in Dupuytren fascia, for they mimicked the altered type III/I collagen balance both in cultured Dupuytren's fibroblasts and in control cells simply by increasing cell density.…”

“…Type III collagen is virtually absent in normal palmar fascia, but accumulates in patients with Dupuytren's disease (Brickley‐Parsons et al. 1981; Melling et al. 1999).…”

Dupuytren’s Disease

“…They have also reported the presence of increased cross-linking between chains of type-III collagen in the palmar fascia of diabetics but decreased linking in similar tissue from patients with Dupuytren's disease. 46 Magro et al 47 examined Dupuytren's tissue from 30 patients and, by an immunohistochemical study of the extracellular matrix (ECM), showed that collagen types IV and VI, laminin and fibronectin were strongly expressed and restricted to cellular areas of the involutional and residual phases. They suggested that interactions between myofibroblasts and the surrounding ECM glycoproteins may be involved in the pathophysiology of palmar fibromatosis.…”