Dupuytren’s Disease

Introduction Dupuytren's disease – a historical overview Epidemiology • Prevalence of Dupuytren's disease among Caucasians • The incidence of Dupuytren's disease in Germany • Age and Dupuytren's disease • Sex distribution in Dupuytren's disease • Handedness in digitopalmar contracture Theories concerning aetiology and pathogenesis • Association between trauma and Dupuytren's disease • Ectopic fibromatoses • Hepatic cirrhosis and Dupuytren's disease • Alcohol abuse • Nicotine abuse • Epilepsy • The hypothesis of a neurogenic origin of Dupuytren's disease • Hereditary factors • Dupuytren's diathesis • Coincidence of Dupuytren's disease and disorders of the immune system • Dupuytren's disease in diabetes • Vascular disease • Oxygen free radicals and induction of Dupuytren's disease Ground substance and cells of the extracellular matrix • The extracellular matrix • Fibrous proteins • Glucosaminoglycans of the extracellular matrix • Fascial and plasmatic patterns of glycosaminoglycans in Dupuytren's disease • Interactions between collagens, glycosaminoglycans, and fibroblasts Subjective complaints Symptoms of Dupuytren's contracture Course of Dupuytren's contracture Anatomy of the palmar fascia (G M RAYAN) • Development of the palmar fascia • Anatomy of the palmar fascia Classification Conservative treatments Surgical goals Surgical indications • Thoughts on the indication in the nodular and cord stages • Mechanical strains Selection of surgical techniques • Indications for fasciotomy and different forms of fascietomies • Indications for additional measures • Indications for additional simultaneous interventions • Indications in recurrent disease Contraindications Informed consent Preoperative workup Instruments Anaesthesia and positioning Operative technique • Remarks on skin incisions • Approaches to fingers and palm • Excision of the tissueaffected by Dupuytren´s disease • Skin suture Additional measures to improve hand function • Fixed flexion deformity at the interphalangeal joints • Extension methods • Remarks on teno- and arthrolysis • Corrective osteotomy • Arthrodeses • Amputation Postoperative treatment • Follow up treatment after minimal invasive procedures • Postoperative management after partial and total fasciectomy • Specifics of the open palm technique • Aftercare following skin grafts and local flaps • Aims of physical and occupational therapy Errors, hazards and complications • Hematomas • Lesions of the neurovascular bundles • Necrosis of the wound margin • Graft failure • Flap necrosis • Reflex sympathetic dystrophy (algodystrophy) Results • Functional results and recurrence rates • Complications dependingon the surgical technique Conclusions References Subject index