Dupuytrens DiseaseDupuytrens Disease

Dr Steve CarterDr Steve Carter

IntroductionIntroduction Dupuytrens description 1831Dupuytrens description 1831 Plater 1614 Scandinavian literature 1700Plater 1614 Scandinavian literature 1700 Cline proposed fasciectomy in 1787Cline proposed fasciectomy in 1787 Cooper performed first fasciectomy 1822Cooper performed first fasciectomy 1822

EpidemiologyEpidemiology Common in Northern Europe 16% rises to 60% in Common in Northern Europe 16% rises to 60% in

relativesrelatives Associations, diabetes, TB, Aids,Seizure disorders minor Associations, diabetes, TB, Aids,Seizure disorders minor

traumatrauma Essentially Fibroblasts converted to myofibroblasts Essentially Fibroblasts converted to myofibroblasts

Anatomy / PathophysiologyAnatomy / Pathophysiology Palmar fascia triangular shape base at mcpsPalmar fascia triangular shape base at mcps 4 longitudinal bands attached to skin intrinsic muscles4 longitudinal bands attached to skin intrinsic muscles

Anatomy / PathophysiologyAnatomy / Pathophysiology Begins as a palmar noduleBegins as a palmar nodule Extends distally as a cord Type 3 collagen Extends distally as a cord Type 3 collagen

myofibroblastsmyofibroblasts

ClinicalClinical Nodule / contractureNodule / contracture Activities of daily livingActivities of daily living Knuckle padsKnuckle pads Ledderhose Peyronies diseaseLedderhose Peyronies disease Other assoc CTS Trigger fingerOther assoc CTS Trigger finger Differentiation from BoutonniereDifferentiation from Boutonniere

Non operative treatmentNon operative treatment Steroids Anti-inflamatoriesSteroids Anti-inflamatories Clostridium collegenase Clostridium collegenase Mainstay of treatment remains surgicalMainstay of treatment remains surgical

Surgical IndicationsSurgical Indications Activities of daily living, Table top testActivities of daily living, Table top test MCP > 30 degree contractue MCP > 30 degree contractue PIP > 20 Degree contracturePIP > 20 Degree contracture

Surgical IndicationsSurgical Indications

Surgical treatmentSurgical treatment Fasciotomy Fasciotomy

Regional FasciectomyRegional Fasciectomy

Total FasciectomyTotal Fasciectomy

DermatofasciectomyDermatofasciectomy

Segmental AponeurectomySegmental Aponeurectomy

McCash open palm techniqueMcCash open palm technique

Surgical treatmentSurgical treatment Skin IncisionsSkin Incisions

Surgical treatmentSurgical treatment DissectionDissection

Surgical treatmentSurgical treatment Joint releaseJoint release

Surgical treatmentSurgical treatment HeamostasisHeamostasis

Surgical treatmentSurgical treatment Skin ClosureSkin Closure

Surgical treatmentSurgical treatment PostoperativePostoperative

Surgical treatmentSurgical treatment

ComplicationsComplications HeamatomaHeamatoma Skin necrosesSkin necroses InfectionInfection Digital nerve and arteryDigital nerve and artery RSDRSD StiffnessStiffness Loss of strengthLoss of strength RecurrenceRecurrence

ConclusionConclusion