Dupuytren’s Disease: A Concept of Surgical Treatment

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Springer Science & Business Media, Feb 26, 2003 - Medical - 241 pages
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Morbus Dupuytren is particularly widespread among northern Europeans. However, the therapeutic success-rate often leaves much to be desired. A 50% recurrence-rate after surgery indicates that the disease cannot be treated by surgery alone. This book therefore adopts two parallel approaches: emphasis is firstly placed on the systemic character of morbus Dupuytren in context with other connective tissue diseases by a description of the biochemical and molecular-biological changes in the diseased connective tissues; secondly, a diversified picture of the given anatomical facts serves to explain the employment of the various therapeutic approaches. Further, a description is given of the current surgical procedures.
 

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Contents

Introduction
1
Dupuytrens diseasea historical overview
4
Epidemiology
6
34 Sex distribution of Dupuytrens disease
7
35 Handedness in digitopalmar contracture
8
Theories concerning etiology and pathogenesis
9
42 Ectopic fibromatoses
10
422 Plantar fibromatosis
11
131214 Spiral cord
90
131215 Lateral cord
93
131221 The retaining ligaments of the extensor mechanism
94
131222 The Grayson and Cleland ligaments
97
1313 Longitudinal section of the digitopalmar continuum
99
1314 The horizontal and threedimensional arrangement of the digitopalmar continuum
101
132 Mechanical strain
104
Selection of surgical techniques
105

423 Penile fibromatosis
12
43 Hepatic cirrhosis and Dupuytrens disease
14
45 Nicotine abuse
15
48 Hereditary factors
16
49 Dupuytren diathesis
17
4102 AIDS
18
412 Vascular disease
19
413 Oxygen free radicals and induction of Dupuytrens disease
20
Ground substance and cells of the extracellular matrix
23
52 Fibrous proteins
27
522 Adhesive proteins
28
53 Glycosaminoglycans of the extracellular matrix
29
532 Particularities of hyaluronic acid
31
54 Fascial and plasmatic patterns of glycosaminoglycans in Dupuytrens disease
32
55 Interactions between collagens glycosaminoglycans and fibroblasts
35
Subjective complaints
37
Symptoms of Dupuytrens contracture
38
Course of Dupuytrens contracture
45
Anatomy of the palmar fascia G M Rayan
46
92 Anatomy of the palmar fascia
47
921 Ulnar aponeurosis
51
922 Radial aponeurosis
53
923 Central palmar aponeurosis
54
9231 Longitudinal fibers
55
9232 Transverse fibers
56
9233 Vertical fibers
57
924 Palmodigital fascia
60
925 Digital fascia
62
Classification
67
Conservative therapy
79
Surgical goals
83
Surgical indications
84
1312 The cord stage
85
131211 Pretendinous cord
87
131213 Cords of the superficial transverse metacarpal ligament natatory cord
89
1416 Total fasciectomy
106
143 Indications for additional simultaneous interventions
107
Contraindications
108
Informed consent
109
Preoperative work up
110
Instruments
111
Anesthesia and positioning
112
Operative technique
113
203 Excision of the tissue affected by Dupuytrens disease
119
2032 Needle fasciectomy
124
2033 Segmental aponeurectomy
126
2034 Partial fasciectomy
129
2035 The open palm technique
141
2036 Total fasciectomy
147
2037 Dermofasciectomy
153
2038 The continuous elongation technique
156
204 Skin suture
159
2043 Heterodigital flaps
172
2044 Free tissue transfer
180
Additional measures to improve hand function
184
214 Corrective osteotomy
189
215 Arthrodeses
191
216 Amputation
193
Postoperative treatment
196
225 Aims of physical and occupational therapy
197
Errors hazards and complications
198
233 Necrosis of the wound margin
199
236 Reflex sympathetic dystrophy algodystrophy
200
Results
201
242 Complications depending on the surgical technique
202
Conclusions
207
References
213
Subject index
229
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