Morbus Dupuytren is particularly widespread among northern Europeans. However, the therapeutic success-rate often leaves much to be desired. A 50 per cent 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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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
