Description
(Text)
Morbus Dupuytren is particularly widespread among northern Europeans. However, 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. Further, a description is given of the current surgical procedures.
(Table of content)
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 glycosaminoglycansin 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 atthe 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
