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Deutsches Arzteblatt International Nov 2021The worldwide prevalence of Dupuytren's disease (DD) is 8%. DD is a chronic disease for which there is no cure. Various treatments are available. (Review)
Review
BACKGROUND
The worldwide prevalence of Dupuytren's disease (DD) is 8%. DD is a chronic disease for which there is no cure. Various treatments are available.
METHODS
This review is based on pertinent publications retrieved by a selective search in PubMed and Embase.
RESULTS
Genetic factors account for 80% of the factors involved in causing this disease. Diabetes mellitus, hepatic diseases, epilepsy, and chronic occupational use of vibrating tools are also associated with it. Limited fasciectomy is the most common treatment and is considered the reference standard. Possible complications include persistent numbness in areas where the skin has been elevated, cold sensitivity, and stiffness, with a cumulative risk of 3.6 -39.1% for all complications taken together. The recurrence rate at 5 years is 12-73%. Percutaneous needle fasciotomy is the least invasive method, with more rapid recovery and a lower complication rate than with limited fasciectomy. 85% of patients have a recurrence after an average of 2.3 years. Radiotherapy can be given before contractures arise in patients with high familial risk, or postoperatively in selected patients with a very high individual risk of recurrence.
CONCLUSION
Although DD is not curable, good treatments are available. Recurrences reflect the pathophysiology of the disease and should not be considered complications of treatment. When counseling patients about the available treatment options, particularly the modalities and timing of surgery, the physician must take the patient's degree of suffering into account. Nowadays, fast recovery from surgery and less postoperative pain are a priority for many patients. Different surgical methods can be used in combination. It remains difficult to predict the natural course and the time to postoperative recurrence in individual patients; these matters should be addressed in future studies.
Topics: Dupuytren Contracture; Fasciotomy; Humans; Needles; Orthopedic Procedures; Research Design
PubMed: 34702442
DOI: 10.3238/arztebl.m2021.0325 -
Journal of Clinical Orthopaedics and... 2020Dupuytren's contracture is a common condition that has the potential to be debilitating. It presents in a variety of manners and can be mild or more aggressive in its...
Dupuytren's contracture is a common condition that has the potential to be debilitating. It presents in a variety of manners and can be mild or more aggressive in its progression. There are a large number of management options currently available. In this review of the evidence, non-operative and operative management options are examined, with a consideration of post-operative rehabilitation and complications. A summary of the current concepts in the management of Dupuytren's contracture is presented.
PubMed: 32684695
DOI: 10.1016/j.jcot.2020.03.026 -
Clinical Anatomy (New York, N.Y.) Jul 2022The deep fascia is a three-dimensional continuum of connective tissue surrounding the bones, muscles, nerves and blood vessels throughout our body. Its importance in... (Review)
Review
The deep fascia is a three-dimensional continuum of connective tissue surrounding the bones, muscles, nerves and blood vessels throughout our body. Its importance in chronically debilitating conditions has recently been brought to light. This work investigates changes in these tissues in pathological settings. A state-of-the-art review was conducted in PubMed and Google Scholar following a two-stage process. A first search was performed to identify main types of deep fasciae. A second search was performed to identify studies considering a deep fascia, common pathologies of this deep fascia and the associated alterations in tissue anatomy. We find that five main deep fasciae pathologies are chronic low back pain, chronic neck pain, Dupuytren's disease, plantar fasciitis and iliotibial band syndrome. The corresponding fasciae are respectively the thoracolumbar fascia, the cervical fascia, the palmar fascia, the plantar fascia and the iliotibial tract. Pathological fascia is characterized by increased tissue stiffness along with alterations in myofibroblast activity and the extra-cellular matrix, both in terms of collagen and Matrix Metalloproteases (MMP) levels. Innervation changes such as increased density and sensitization of nociceptive nerve fibers are observed. Additionally, markers of inflammation such as pro-inflammatory cytokines and immune cells are documented. Pain originating from the deep fascia likely results from a combination of increased nerve density, sensitization and chronic nociceptive stimulation, whether physical or chemical. The pathological fascia is characterized by changes in innervation, immunology and tissue contracture. Further investigation is required to best benefit both research opportunities and patient care.
Topics: Back Muscles; Chronic Pain; Connective Tissue; Dupuytren Contracture; Fascia Lata; Humans
PubMed: 35417568
DOI: 10.1002/ca.23882 -
Hand Clinics Aug 2023Dupuytren disease is a common pathologic condition that can be especially challenging to hand surgeons in recurrent or severe contractures. Recurrence risk may be... (Review)
Review
Dupuytren disease is a common pathologic condition that can be especially challenging to hand surgeons in recurrent or severe contractures. Recurrence risk may be reduced with a variety of techniques, including skin grafting, external fixator application, radiation, and many others described in this article. Management of recurrence requires special attention to anatomy at risk. Adjuvant therapy may help to prevent the progression or recurrence of severe disease.
Topics: Humans; Dupuytren Contracture; Skin Transplantation; Skin; Treatment Outcome
PubMed: 37453772
DOI: 10.1016/j.hcl.2023.03.006 -
MMW Fortschritte Der Medizin Oct 2022
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Acta Chirurgiae Plasticae 2023This paper describes the evaluation options of Dupuytren's contracture by subjective and objective methods. There are various classification schemes named after their... (Review)
Review
This paper describes the evaluation options of Dupuytren's contracture by subjective and objective methods. There are various classification schemes named after their authors, including graphical representation for objective evaluation of the disease. Subjective assessment was performed in the form of a questionnaire for patients. The QuickDASH with a small specification for Dupuytren's contracture is the most commonly used questionnaire. The Southampton Dupuytren's Scoring Scheme questionnaire appears to be a higher specification. The classifications allow evaluation of treatment success to determine prognosis of the disease. The analysis of articles is based on PubMed search from the years 1967-2022, with 28 relevant articles were retrieved. Based on this analysis, the Tubiana classification appears to be the most appropriate one for patients with Dupuytren's contracture. Of patient questionnaires, the Southampton Dupuytren's Scoring Scheme meets these parameters.
Topics: Humans; Dupuytren Contracture; PubMed
PubMed: 37722904
DOI: 10.48095/ccachp202374 -
Annals of Plastic Surgery Sep 2021Dupuytren disease is a connective tissue disorder occurring on the palm, causing flexion contractures of fingers. There is a pressing need for therapeutic interventions... (Review)
Review
Dupuytren disease is a connective tissue disorder occurring on the palm, causing flexion contractures of fingers. There is a pressing need for therapeutic interventions that can slow, stop, or even incrementally reverse the progression of the disease. Numerous in vitro studies have shed light on cellular and molecular agents that contribute to contractures. This article comprehensively reviews various growth factors that can be targeted to prevent and limit the progression and recurrence of Dupuytren contracture (DC). Fibroblasts are the major cell population that has been reported for the contractures in DC, and they are also known to exacerbate the cytokine production. Limiting the fibroblast function by targeting the growth factor production will be of great benefit in treating DC. This review will focus on the studies that have shown to limit the exaggerated function of fibroblasts by reducing the expression of profibrotic growth factors by using antagonizing agents.
Topics: Dupuytren Contracture; Fibroblasts; Gene Expression; Humans; Immunologic Factors; Neoplasm Recurrence, Local
PubMed: 33587458
DOI: 10.1097/SAP.0000000000002739 -
Journal of Pathology and Translational... Jul 2021Palmar fibromatosis (Dupuytren disease/contracture) is the most common type of fibromatosis, defined as a benign proliferation of fibroblasts and myofibroblasts. The... (Review)
Review
Palmar fibromatosis (Dupuytren disease/contracture) is the most common type of fibromatosis, defined as a benign proliferation of fibroblasts and myofibroblasts. The disease process is most common in white, middle-aged and older men occurring at the distal palmar crease leading to nodules and contracture, which in many cases recur after surgical treatment. In a similar process, plantar fibromatosis (Ledderhose disease) is a proliferation of fibroblasts and myofibroblasts on the plantar aponeurosis of mostly middle-aged patients that may lead to painful nodules but usually does not lead to contracture. Both processes are histologically similar, composed of a bland cellular proliferation of spindle cells with a bluish appearance and with a variable amount of background collagen, depending on the age of the lesion. The etiology of both lesions is still uncertain, while treatment ranges from observation to surgery, with some pharmacologic agents being investigated with mixed success. In this paper we provide an overview of both processes with regards to clinical and radiologic findings, pathophysiology, diagnosis, treatment, and prognosis.
PubMed: 34225446
DOI: 10.4132/jptm.2021.06.14