Dupuytren's Disease: A Concept of Surgical Treatment
Morbus Dupuytren is particularly widespread among northern Europeans, but the therapeutic success-rate often leaves much to be desired. A 50% 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. In addition to the aspects of conservative therapy, a description is given of the current surgical procedures including the complications typical of the same, and accompanied by basic drawings. The book is intended for all those interested in a comprehensive up-to-date survey of morbus Dupuytren, and in instructive information on the established therapeutic concepts.
| Author: |
P. Brenner, G. M. Rayan |
| ISBN: |
321183656X |
| Publisher: |
Springer Verlag |
| Binding: |
Hardcover |
| Year Published: |
Aug 2002 |
| No. of Pages: |
160 |
| Illustrations: |
150 |
| Contents: |
1. Introduction
2. Dupuytren's contracture - overview of its medical history
3. Epidemiology
3.1. Prevalence of Dupuytren's contracture among Caucasian (white) people
3.2. Incidence of Dupuytren's contracture in Germany
3.3. Age and Dupuytren's contracture
3.4. Sex distribution in Dupuytren's contracture
3.5. Left- or right-handedness in digitopalmar contracture
4. Theories about aetiology and pathogenesis
4.1. Association between trauma and Dupuytren's contracture
4.2. Ectopic fibromatoses
4.2.1. Garrod's knuckle pads
4.2.2. Plantar fibromatosis
4.2.3. Penile fibromatosis
4.3. Cirrhosis of the liver and Dupuytren's contracture
4.4. Alcohol misuse
4.5. Nicotine abuse
4.6. Epilepsy
4.7. Neurogenic hypothesis of Dupuytren's contracture
4.8. Hereditary factors
4.9. Dupuytren's diathesis
4.10. Coincidence of Dupuytren's contracture and disorders of the immune system
4.10.1. Autoimmune disorders
4.10.2. AIDS
4.11. Dupuytren's disease in patients with diabetes
4.12. Vascular disease
4.13. Oxygen radicals and induction of Dupuytren's
5. Basic substance and cells of the extracellular matrix
5.1. The extracellular matrix
5.2.1. Mobile and stationary cells of the extracellular matrix
5.2.2. Fibrous proteins
5.2.2.1. Structural proteins
5.2.2.2. Adhesive proteins
5.2.3. Glucosaminoglycans of the extracellular matrix
5.2.3.1. Structure and function of the glucosaminoglycanes
5.2.3.2. Particularities of hyaluronic acid
5.2.3.3. Chondroitin and its analogues
5.2.3.4. The dermatan group
5.2.4. Fascia and plasma patterns of glycosaminoglycans in Dupuytren's disease
5.2.5. Interactions between collagens, glycosaminoglycans, and fibroblasts
6. Subjective complaints
7. Symptoms of Dupuytren's contracture
8. Course of Dupuytren's contracture
9. Anatomy of the palmar fascia (G M RAYAN)
9.1. Development of the palmar fascia
9.2. Anatomy of the palmar fascia
9.2.1. Ulnar aponeurosis
9.2.2. Radial aponeurosis
9.2.3. Central (palmar) aponeurosis
9.2.3.1. Longitudinal fibres
9.2.3.2 Transverse fibres
9.2.3.3. Vertical fibres
9.2.4. The digitopalmar fascia
9.2.5. The digital fascia
10. Classification
11. Conservative treatments
12. Aim of surgery
13. Surgical indications
13.1. Thoughts on the indication in the nodal and cord stages
13.1.1. The nodule stage
13.1.2. The cord stage
13.1.2.1. Surgical macropathology of the cords
13.1.2.1.1. Pretendinous cord
13.1.2.1.2. Central cord
13.1.2.1.3. Cords of the Ligamentum metacarpale transversum superficiale ("natatory cord")
13.1.2.1.4. Spiral cord
13.1.2.1.5. Lateral cord
13.1.2.2. The digital ligaments
13.1.2.2.1. The retaining ligaments of the extensor apparatus
13.1.2.2.2. The GRAYSON and CLELAND ligaments
13.1.2.3. Longitudinal section of the digitopalmar continuum
13.1.2.4. Horizontal and threedimensional arrangement of the digitopalmar continuum
13.1.2.5. Mechanical strains
14. Choice of surgical method (the classical methods)
14.1.1. Fasciotomy
14.1.2. Needle "fasciectomy"
14.1.3. Segment resection
14.1.4. Partial fasciectomy
14.1.5. Indication for the "open palm technique"
14.1.6. Total fasciectomy
14.1.7. When to use dermatofasciectomy
14.2. Indications for additional measures
14.2.1. Arthrolysis
14.2.2. Arthroplasty
14.2.3. Arthrodesis
14.2.4. Amputation
14.2.5. Continuous elongation technique (TEC)
14.3. Indications for further simultaneous interventions
14.4. Indications in case of relapse
14.4.1. Genuine and false relapse
15. Contraindications
16. Patient education
17. Preparation of surgery
18. Instruments
19. Anaesthesia and positioning
20.1. General observations about skin incisions
20.2. Access points on fingers and palm
20.3. Resection of the diseased Dupuytren's tissue
20.3.1. Fasciotomy
20.3.2 Needle "fasciectomy"
20.3.3. Segment fasciectomy
20.3.4. Partial fasciectomy
20.3.5. The open palm technique
20.3.6. Total fasciectomy
20.3.7. Dermofasciectomy
20.3.8. The continuous elongation technique
20.4. Skin suture
20.4.1. Skin transplants
20.4.2. Homodigital flap grafts
20.4.3. Heterodigital flaps
20.4.4. Free transport of tissues
21. Additional measures to improve manual function
21.1. Contractures of the small digital joints
21.2. Extension methods
21.3. Teno-and arthrolysis
21.4. Corrective osteotomy
21.5. Arthrodeses
21.6. Amputation
22. Postoperative treatment
22.1. Follow up treatment after minimally invasive procedures
22.2. Postoperative management after partial and total fasciectomy
22.3. Specifics of the open palm technique
22.4. Aftercare in cases of transplantation and local flaps
22.5. Aims of physio- and ergotherapy
23. Mistakes, risks, complications
23.1. Haematomas
23.2. Lesions of the vascular nerves
23.3. Necrosis of wound margin/EDGE
23.4. Loss of the transplant
23.5. Flap necrosis
23.6. Dystrophy of reflexes
24. Results
24.1. Functional results and rates of relapse
24.2. Complications depending on surgical method
25. Conclusions
26. Bibliography
27. Acknowledgements |
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