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P Vanek, J Strömberg, J Fridén, Y Aurell
The morphology of the pretendinous cord in Dupuytren's disease is poorly described in vivo and especially with respect to recurrence after treatment. This prospective study was designed to describe the morphology of Dupuytren's cords by ultrasound and to identify possible correlation between the ultrasonographic characteristics of these cords and the clinical outcomes two years after treatment. Thirty-nine patients with a contracture of at least 20° in the metacarpophalangeal (MCP) joint, who were scheduled for local treatment by either injectable collagenase clostridium histolyticum (CCH) or percutaneous needle fasciotomy (PNF), were examined by ultrasound...
May 9, 2018: Journal of Plastic Surgery and Hand Surgery
María Rocío Villegas, Alejandro Baeza, Alicia Usategui, Pablo L Ortiz-Romero, José L Pablos, María Vallet-Regí
Fibrosis is a common lesion in different pathologic diseases and defined by the excessive accumulation of collagen. Different approaches have been used to treat different conditions characterized by fibrosis. The FDA and EMA approved the use of collagenase to treat palmar fibromatosis (Dupuytren's contracture). The EMA approved additionally its use in severe Peyronie's disease, but it has been used off label in other conditions.[1,2] The approved treatment includes up to three (in palmar fibromatosis) or up to eight (in penile fibromatosis) injections followed by finger extension or penile modeling procedures, typically causing severe pain...
May 4, 2018: Acta Biomaterialia
Christian Fagernæs, Susanne Mallet
INTRODUCTION: The purpose of this study was to explore if there was a correlation between joint level and degree of contracture on the one hand and the risk of skin tear in Dupuytren's disease (DD) on the other, when treated with collagenase from Clostridium histolyticum. No trial or study has explored the risk of skin tear as primary outcome in a population that has not been treated for DD before. METHODS: A retrospective study of prospectively collected data was performed on patients with DD treated with collagenase from 1 August 2012 to 1 April 2014...
May 2018: Danish Medical Journal
Alistair R M Macey, Roshin Thomas
The anatomy of the cords that form in Dupuytren's disease is complicated and a spiral cord is the most challenging variant to address. It displaces the neurovascular bundle toward or beyond the midline and closer to the skin. This article illustrates the surface anatomy of the neurovascular spiral to help surgeons identify this zone of danger that the authors term "the serpentine zone." Careful dissection in this zone will help avoid iatrogenic digital neurovascular injury.
April 2018: Journal of Hand and Microsurgery
Rafael Sanjuan-Cerveró, Francisco J Carrera-Hueso, Pedro Vazquez-Ferreiro, Clayton A Peimer
Procedural pain is one of the most common adverse effects reported by patients with Dupuytren disease (DD) treated with collagenase clostridium histolyticum (CCH). The aim of this study was to assess the effectiveness of wrist block before CCH injection in reducing procedural pain and to analyze its impact on adverse effects. We performed a prospective, single-center study in which we compared two groups of patients in a consecutive cohort. In the first group (NO-BLOCK), wrist block was only performed before finger extension, whereas in the second group (BLOCK), it was performed before CCH injection and finger extension...
April 12, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Prem Kumar Viji Babu, Carmela Rianna, Gazanfer Belge, Ursula Mirastschijski, Manfred Radmacher
Mechanical properties of myofibroblasts play a key role in Dupuytren's disease. Here, we used atomic force microscopy to measure the viscoelastic properties of 3 different types of human primary fibroblasts derived from a same patient: normal and scar dermal fibroblasts and palmar fascial fibroblasts from Dupuytren's nodules. Different stiffness hydrogels (soft ~1 kPa and stiff ~ 50 kPa) were used as cell culture matrix to mimic the mechanical properties of the natural tissues, and atomic force microscopy step response force curves were used to discriminate between elastic and viscous properties of cells...
April 27, 2018: Journal of Molecular Recognition: JMR
Steven E R Hovius
The author presents his transition of his preferred methods for managing acute trauma and degenerative and congenital conditions of the hand. Based on his career-long experience, he discusses conceptual evolution and current status of treatment of Dupuytren's disease and several congenital anomalies of the hand.
May 2018: Journal of Hand Surgery, European Volume
Chao Zhou, Iris E Ceyisakar, Steven E R Hovius, Reinier Feitz, Harm P Slijper, Hester F Lingsma, Ruud W Selles
OBJECTIVE: For a number of major complex surgical procedures, the outcomes are better when performed by surgeons with higher procedure volumes. The purpose of this study was to examine the relations between surgeon procedure volume and the outcomes of Dupuytren's surgery. DESIGN: Observational study from 2011-14 SETTING:: Consortium of 6 dedicated hand surgery practice sites in The Netherlands PARTICIPANTS:: 588 patients who underwent surgery for Dupuytren's contracture by one of the 16 surgeons from the participating sites...
March 28, 2018: Plastic and Reconstructive Surgery
J Kníže, J Miletín, A Nejedlý, M Chorvát, K Novotná, P Tichá, A Fibír, A Sukop, A Knížetová
Dupuytren's disease (fibromatosis of the palmar fascia, benign neoplastic fibromatosis, Dupuytren's contracture) is a disease characterized by growth and successive contracture of single parts of the palmar aponeurosis. This condition is known and has been treated for several centuries. In the advanced stages of the disease, it leads to significant limitation of hand function, resulting in reduced quality of life of the patient. Dupuytren's disease (DD) is a life-long disease with a variable course and a heterogeneous clinical presentation...
2018: Acta Chirurgiae Plasticae
Christopher M Dress, Elisabet K Tassis
Dupuytren's disease (DD) is a rare connective tissue disorder resulting in progressive fibrosis and thickening of the palmar fascia, and contracture of the fingers due to excessive collagen deposition. Staged surgical interventions are reserved for severe cases, yet worsening of fibrosis and contracture of fingers post-surgery, has been reported to have a recurrence rate as high as 85%. Here, the authors report on use of viable cryopreserved placental membrane (vCPM) allograft as an adjunct to open fasciectomy...
March 2018: Journal of Surgical Case Reports
Kirin Tan, Helen D Brasch, Bede van Schaijik, James R Armstrong, Reginald W Marsh, Paul F Davis, Swee T Tan, Tinte Itinteang
Background: The pathogenesis of Dupuytren's disease (DD) remains unclear. An embryonic stem cell (ESC)-like population in the endothelium of the microvessels around tissues that expresses components of the renin-angiotensin system (RAS) has been reported. This study investigated if this primitive population expresses cathepsins B, D, and G, that contribute to RAS bypass loops. Methods: 3,3-Diaminobenzidine immunohistochemical (IHC) staining for cathepsins B, D, and G was performed on sections of formalin-fixed paraffin-embedded DD cords (n = 10) and nodules (n = 10)...
February 2018: Plastic and Reconstructive Surgery. Global Open
Mikko P Räisänen, Teemu Karjalainen, Harry Göransson, Aleksi Reito, Hannu Kautiainen, Antti Malmivaara, Olli V Leppänen
INTRODUCTION: Dupuytren's contracture (DC) is a chronic fibroproliferative disorder of the palmar fascia which leads to flexion contracture in one or more fingers. There is no definitive cure for DC, and treatment aims at relieving symptoms by releasing the contracture using percutaneous or operative techniques. METHODS AND ANALYSIS: We planned a prospective, randomised, controlled, outcome assessor-blinded, three-armed parallel 1:1:1, multicentre trial comparing the effectiveness and cost of (1) collagenase clostridium histolyticum injection followed by limited fasciectomy in non-responsive cases, (2) percutaneous needle fasciotomy followed by limited fasciectomy in non-responsive cases and (3) primary limited fasciectomy during short-term and long-term follow-up for Tubiana I-III stages DC...
March 28, 2018: BMJ Open
Carla Stecco, Veronica Macchi, Alessandro Barbieri, Cesare Tiengo, Andrea Porzionato, Raffaele De Caro
INTRODUCTION: There are few data in the scientific literature about the innervation of fasciae of the hand. The present study first elucidates the density and location of nervous structures in the palmar aponeurosis and, for comparison, in the flexor retinaculum (both can be considered specializations of the deep fascia of the upper limbs). Second, it compares non-pathological with pathological palmar aponeurosis. MATERIALS AND METHODS: Samples of non-pathological fascia were taken from the flexor retinaculum and palmar aponeurosis of 16 upper limbs of unembalmed cadavers...
March 25, 2018: Clinical Anatomy
Rafael Sanjuan-Cervero, Francisco J Carrera-Hueso, Salvador Oliver-Mengual, Maria A Ramon-Barrios, Clayton A Peimer, Narjis Fikri-Benbrahim
BACKGROUND: Dupuytren's contracture produces a progressive flexion contracture of the affected fingers. Collagenase Clostridium histolyticum produces breakdown of the cord in the hand and/or finger(s) that tightens as a result of the disease creating a contracture, allowing manual traction and cord rupture. One of the side effects is spontaneous skin laceration when the finger is extended. OBJECTIVES: To evaluate the development of skin lacerations in Dupuytren's contracture treated with collagenase Clostridium histolyticum, to determine predisposing factors, and evaluate the effectiveness of 2 different treatments (antiseptic and non-antiseptic dressings)...
March 2018: Orthopaedic Nursing
Roman Hari, Michael Harris, Peter Frey, Sven Streit
BACKGROUND: Exposure to a broad spectrum of patient cases is a mainstay of undergraduate medical education. This study aimed to assess how many primary care-specific clinical pictures final-year medical students in traditional block rotations had encountered, and how this changed after a curricular change that included the implementation of a four-year longitudinal clerkship in primary care. METHODS: Final-year students before, and after, implementation of the clerkship were asked which of the clinical pictures most relevant to primary care they had seen...
March 14, 2018: BMC Medical Education
Lynn E Murphy, Karen M Murphy, Shauneen M Kilpatrick, Neville W Thompson
Introduction: Collagenase Clostridium Histolyticum (CCH) is a recognised treatment option for adult patients presenting with Dupuytren's contracture (DC). Patients and Methods: Twenty male patients with established DC were treated using CCH. The average metacarpophalangeal (MCP) joint and proximal interphalangeal joint (PIP) contractures pre-treatment were 520 (range, 0 - 750 ) and 350 (range, 0 - 840 ) respectively. The average DASH score pre-treatment was 24.2 points (range, 0 - 68...
May 2017: Ulster Medical Journal
Marko Bergovec, Josko Jelicic, Ana Oljaca, Ranko Bilic
PURPOSE: The aim of this study was to analyze long-term results after limited fasciectomy for Dupuytren's contracture. METHODS: The study included 34 patients (52 rays), with an average follow-up of 9.5 years (range: 7-13 years). Range of motion, functional status, recurrence, and complications were recorded. RESULTS: Preoperative metacarpophalangeal joint (MCPJ) contracture (median: 35°, range: 0-90°) improved postoperatively to full extension in all but one patient, with no recurrence at the most recent follow-up...
January 2018: Journal of Orthopaedic Surgery
R Sanjuán-Cerveró, P Vazquez-Ferreiro, D Gómez-Herrero, F J Carrera-Hueso, N Fikri-Banbrahim
Aim Clostridium histolyticum collagenase (CCH) is nowadays an alternative treatment for the contracture of Dupuytren. Our objective is to assess its effectiveness at one year in a series of consecutive patients. MATERIAL AND METHOD: Prospective study with minimum follow-up of one year. Evaluation of results and adverse effects. RESULTS: A total of 75 joints treated in 51 patients were included. The average age was 65.18years (SD: 7.288) and 82.7% were males. The initial mean contraction of the MCP was 34...
March 5, 2018: Revista Española de Cirugía Ortopédica y Traumatología
Jason Silvestre, Joseph Upton, Benjamin Chang, David R Steinberg
BACKGROUND: Hand surgery fellowship programs in the United States are predominately sponsored by departments or divisions of orthopaedic surgery or plastic surgery. This study compares the operative experiences of hand surgery fellows graduating from orthopaedic or plastic surgery hand surgery fellowships. METHODS: Operative case logs of 3 cohorts of hand surgery fellows graduating during the academic years of 2012-2013, 2013-2014, and 2014-2015 were analyzed. The median case volumes were compared by specialty via Mann-Whitney U tests...
March 7, 2018: Journal of Bone and Joint Surgery. American Volume
Dieuwke C Broekstra, Henk Groen, Sanne Molenkamp, Paul M N Werker, Edwin R van den Heuvel
BACKGROUND: The role of diabetes mellitus, liver disease, and epilepsy as risk factors for Dupuytren disease remains unclear. In this systematic review and meta-analysis, the strength and consistency of these associations were examined. METHODS: The MEDLINE, EMBASE, and Web of Science databases were searched for articles reporting an association between Dupuytren disease and diabetes mellitus, liver disease, and epilepsy published before September 26, 2016. The frequencies of Dupuytren disease and diabetes mellitus, liver disease, and epilepsy were extracted, as was information on potential confounders...
March 2018: Plastic and Reconstructive Surgery
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