DUPUYTREN DISEASE.pptx

DR. YUSRA JAMSHED (P.G. YI- GENERAL SURGERY) 1

 Three dimensional scaffold
 This scaffolding
 Anchors the skin to hand skeleton
 Redistributes shear forces on palm
 Resists tissue translation for a secure grip
Grabb WC, Smith JW, Chung KC. Chapter 85. In: Grabb and Smith's plastic surgery. Philadelphia, Pa: Wolters Kluwer; 2020. p. 858–64.
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 It can be divided into three layers for purpose of simplification
 Superficial layer
 Intermediate layer
 Deep layer
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Dupuytren anatomy [Internet]. Dupuytren Research Group. [cited 2022Dec30]. Available from: https://dupuytrens.org/dupuytren-anatomy/#gsc.tab=0
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Dupuytren anatomy [Internet]. Dupuytren Research Group. [cited 2022Dec30]. Available from: https://dupuytrens.org/dupuytren-anatomy/#gsc.tab=0 5

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 More prevalent in Caucasian descent
 Men are more affected than women
 Onset is common in the sixth decade of life
 Genetic involvement?
 Positive associations have been reported with DM, HIV, hypercholesterolemia,
hypertriglyceridemia, alcohol consumption and smoking
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 Pathological pathway of development
of DD can be divided into three
stages
 Proliferative stage
 Involution stage
 Residual stage
 Relative abundance of type III
collagen.
 Increase in ratio of type III to type I
collagen
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12

Dupuytren anatomy [Internet]. Dupuytren Research Group. [cited 2022Dec30]. Available from: https://dupuytrens.org/dupuytren-anatomy/#gsc.tab=0 13

 Detailed history
 special attention should be given to history for Dupuytren diathesis
 Family history
 Environmental factors
 Examination
 Presence of any prominent nodules
 Presence of cords
 Measurements of contractures
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 A more aggressive form of DD
 Includes
 Male Gender
 Bilateral disease
 Family history
 Garrods pads
 Age of onset <50 years
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 Non-surgical
 Minimally invasive options
 Surgical options
 Adjunctive procedures
 Salvage procedures
17

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 Pharmacological therapy
 Physical therapy
 External beam radiation
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 Needle aponeurectomy
 Hypodermic needle is used to disrupt
the cords
Advantage: Rapid recovery
Minimal invasion
Cost effective
Patient satisfaction
 Disadvantage: Increased chances of
recurrence
Slight risk of damage to
digital nerve
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 Collagenase Clostridium
histiolyticum injection
 Two visits are needed
 CCH injection
 Manipulation of digit into
extension
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Collagenase Clostridium histolyticum [Internet]. Publisso. [cited 2022Dec30]. Available from: https://books.publisso.de/de/publisso_gold/publishing/books/overview/49/70 22

 Fasciotomy
 Limited fasciectomy
 Extended fasciectomy
 McCash Open technique
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 Requires more extensive dissection of diseased fascia and release of contracture
 Operation commences with elevation of skin edges
 Non diseased sub cutaneous tissue left on the skin flap helps preserve blood
supply
 Dissection of cords proceed from proximal to distal
 Excision of diseased fascia should proceed until all contractures are released
 Skin closure can be performed by z-plasties, V-Y advancement flaps
 If closure is not possible, skin grafting can be performed
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 McCash technique is basically leaving the transverse incisions of palms and digits
to heal on basis of daily dressings
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 Full thickness skin grafts
 Dermo fasciectomy
 Soft tissue distraction
 Lipofilling
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 In this technique, the disease as well as the overlying skin is excised and a full-
thickness skin graft is used to resurface the defect.
 Skin graft will act as a barrier and prevent recurrence of the disease
 There is complete excision of the diseased tissue to resurface scarred and fibrotic
skin
Grabb WC, Smith JW, Chung KC. Chapter 85. In: Grabb and Smith's plastic surgery. Philadelphia, Pa: Wolters Kluwer; 2020. p.
858–64.
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 It will stretch the shortened soft tissue, such as neurovascular bundles and
collateral ligaments
 Distraction devices, such as the digit widget, use skeletally anchored hardware to
provide soft tissue distraction
 Afterward, a limited fasciectomy or dermatofasciectomy can be performed.
 Device can be applied under digital block, and extension can be achieved by 05
weeks
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 Through percutaneous aponeurectomy to disintegrate the cords and then
infiltrating the area with autologous lipo infilterate.
 Fat graft may reduce myofibroblast density and cell-cell contact, prevent
recurrence by replacing the deficient sub dermal fat.
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