1	Dupuytrens Disease Chris Bainbridge
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3	History Plater 1614 Cline 1808 Cooper 1822 Dupuytren 1831
4	Basic Science
5	Basic Science Normal Fascia – 95% Type I collagen – 5% Type III collagen Dupuytren’s Fascia – 40% Type III collagen
6	Basic Science Local ischemia leads to fibroblast proliferation Myofibroblasts responsive to growth factors
7	Normal Anatomy • Palmar Aponeurosis • Septi of Legueu and Juvara • Superficial Transverse Palmar Ligament • Pretendinous Band
8	Normal Anatomy • Spiral Band • Natatory Ligament • Lateral Digital Sheath • Cleland’s Ligament • Grayson’s Ligament • Retrovascular Band • Neurovascular Bundle
9	Pathoanatomy • Pathologic change in normal fascia Bands Cords • Myofibroblast produce contractile behavior
10	"MP contracture" MP contracture Pretendinous Cord Thumb web Palmar Aponeurosis Web space Natatory Cord
11	PIP joint Lateral Digital Cord Grayson’s Ligament Central Cord Spiral Cord Retrovascular Cord
12	DIP Joint Lateral Digital Cord Retrovascular Cord
13	Demographics Viking heritage Genetics Complex Multifactorial Mitochondrial element Particular loci now identified
14	Clinical History Age 40 to 60 years (can start younger) Male:Female is 7:1 Pathognomonic Nodule Often tender Usually at base of ring finger
15	Clinical examination Flexion Contractures MP, PIP Bilateral Ectopic Deposits
16	Associated Disease Smoking Alcohol Diabetes Epilepsy
17	Trauma NOT related to manual work MAY appear after a single episode of trauma
18	"• Family History" • Family History • Early Onset • Bilateral - Radial • Ectopic Deposits
19	Operative Indications • “Table Top” Test • MP > 30 degrees • PIP - any contracture
20	Surgical approaches • Fasciotomy – percutaneous needle • Segmental Fasciectomy • Fasciectomy • Radical Fasciectomy
21	Percutaneous needle Fasciotomy This has been a routine technique in my hands for many years. Mainly for Palmar disease affecting MP joint Good short term outcome High complication rate distal to MP joint.
22	Incisions Brunner (zig-zag) Skoog (straight line with Z-plasty) Zig-zag with V-Y extension
23	Wound closure Direct closure with Z-plasty Open palm technique Skin graft
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26	Outcomes • MP correction maintained • PIP recurrence frequent • Loss of flexion
27	Recurrent Disease 26 to 80% Nodule - No treatment Dermofasciectomy with FTG High risk of Nerve damage Cold intolerance Stiffness