The Palmar Fascia after Treatment by the Continuous Extension Technique for Dupuytren’s Contracture

Abstract

After complete elongation using the continuous extension technique the palmar fascia of four patients with Dupuytren's contracture was examined by light and electron microscopy and compared with non-elongated samples from 20 patients at the same clinical stage of the disease. Nodules and cords were no longer clinically recognizable after extension. The tissue contained collagen fibrils of uniform diameter (about 50 nm), densely packed in fibres parallel to the stretching force. Fine filaments (presumably proteoglycans) formed a network which was intermingled with and periodically bound to the collagen fibrils. Fibroblasts and myofibroblasts with an high biosynthetic activity and oxytalan-like microfibrils were aligned along the collagen fibres. The results show that in Dupuytren's disease the contracted palmar fascia reacts to external forces with neoformation and reorientation of all tissue components by myofibroblasts.

The Use of Skeletal Extension Torque in Reversing Dupuytren Contractures of the Proximal Interphalangeal Joint

“…An extension torque about the joint transmits tension forces to both the diseased Dupuytren tissues as well as all other contracted palmar tissues, causing these tissues to increase in length over time. 1,2 It is difficult to determine the etiology of every PIP joint contracture and assess whether the Digit Widget is appropriate; nevertheless, it has been used successfully in reversing PIP joint contractures associated with Dupuytren disease. 3…”

Results After Surgery for Severe Dupuytren's Contracture: Does a Dynamic Extension Splint Influence Outcome?

“…However, we do not know what would have happened if they had not used the splint as they did. Another explanation could be that the external extension force generated by the splint actually stimulated neoformation and reorientation of the tissue components by myofibroblasts as mentioned previously (4). We also have to consider whether the splint was applied too late at two to three weeks after operation.…”

“…A number of traction or extension techniques and splinting programmes has been developed to try and improve this, including dynamic splinting (1,2,4,9,13,14). These techniques can be used as an adjunct to operation when the contraction deformity is stretched before operation to facilitate the dissection (1,4,13). Others use postoperative dynamic extension splinting (2,14).…”

Severe Dupuytren's Contracture of the Proximal Interphalangeal Joint: Treatment by Two-Stage Technique

“…Bailey et al (1994) reported on the biochemical changes in the tissues during distraction, and found increased levels of degradative enzymes such as neutral metalloproteinases (collagenase and gelatinase) and the acidic cathepsins B and L. Both these groups of enzymes depolymerize collagen fibers causing a loss of tensile strength and its resorption. Brandes et al (1994) performed electron microscopy studies of Dupuytren's tissue after distraction and compared this tissue with standard Dupuytren's tissue from patients with the same clinical stage of the disease. Brandes et al (1994) performed electron microscopy studies of Dupuytren's tissue after distraction and compared this tissue with standard Dupuytren's tissue from patients with the same clinical stage of the disease.…”