Palm aponeurosis, also known as Dupuytren’s disease, was initially described by Felix Platter in . A técnica de palma aberta na contratura de Dupuytren. It was observed a higher incidence of Dupuytren’s disease was observed among men, .. Chakkour I., Gomes M.D. Contratura de Dupuytren. Keywords: Dupuytren contracture, Hand, Surgical procedures operative .. Freitas A.D., Pardini A.G., Neder A.L. Contratura de Dupuytren.
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Dupuytren’s contracture is a condition in which one or more fingers become permanently bent in a flexed position. While typically not painful some aching or itching may be present. The cause is unknown. Initial treatment is typically with steroid injections into the affected area and physical therapy.
Dupuytren’s most often occurs in males over the age of Typically, Dupuytren’s contracture first presents as a thickening or nodule in the palm, which initially can be with or without pain. Generally, the cords or contractures are painless, but, rarely, tenosynovitis can occur and produce pain. The most common finger to be affected is the ring finger; the thumb and index finger are much less often affected. In Dupuytren’s contracture, the palmar fascia within the hand becomes abnormally thick, which can cause the fingers to curl and can impair finger function.
The main function of the palmar fascia is to increase grip strength; thus, over time, Dupuytren’s contracture decreases a person’s ability to hold objects. People may report pain, aching and itching with the contractions. Normally, the palmar fascia consists of collagen type Ibut in Dupuytren sufferers, the collagen changes to collagen type IIIwhich is significantly thicker than collagen type I.
In severe cases, the area where the palm meets the wrist may develop lumps. Severe Dupuytren disease may also be associated with frozen shoulder adhesive capsulitis of shoulderPeyronie’s disease of the penis, increased risk of several types of cancer, and risk of early death, but more research is needed to clarify these relationships. In one study, those with stage 2 of the disease were found to have a slightly increased risk of mortality, especially from cancer.
Treatment is indicated when the so-called table top test is positive. With this test, the person places their hand on a table. If the hand lies completely flat on the table, the test is considered negative. If the hand cannot be placed completely flat on the table, leaving a space between the table and a part of the hand as big as the diameter of a ballpoint penthe test is considered positive and surgery or other treatment may be indicated. Additionally, finger joints may become fixed and rigid.
Treatment involves one or more different types of treatment with some hands needing repeated treatment. The main categories listed by the International Dupuytren Society in order of stage of disease are radiation therapyneedle aponeurotomy NAcollagenase injection and hand surgery. Needle aponeurotomy is most effective for Stages I and II, covering 6—90 degrees of deformation of the finger. However, it is also used at other stages. Collagenase injection is likewise most effective for Stages I and II.
Evaluation of surgical treatment of Dupuytren’s disease by modified open palm technique
On June 12,Dupuytren performed a dupuyytren procedure on conttatura person with contracture of the 4th and 5th digits who had been previously told by other surgeons that ve only remedy was cutting the flexor tendons.
Because of high recurrence rates, [ citation needed ] new surgical dupuytrdn were introduced, such as fasciectomy and then dermofasciectomy. Most of the diseased tissue is removed with these procedures. Recurrence rates are high.
After removal of the wires, the joint is fixed into flexion, which is considered contrxtura to fusion at extension. In extreme cases, amputation of fingers may be needed for severe or recurrent cases or after surgical complications.
During the procedure, the person is under regional or general anesthesia. A surgical tourniquet prevents blood flow to the limb. In the case of a shortage of skin, the duupuytren part of the zig-zag incision is left open.
Stitches are removed 10 days after surgery. After surgery, the hand is wrapped in a light compressive bandage for one week. People start bending and extending their fingers as soon as the anesthesia has resolved. Hand therapy is often recommended.
InDenkler described the technique. Dermofasciectomy is a surgical procedure that is mainly used in recurrences and for people with a high chance of a conteatura of Dupuytren’s contrattura. In most ds the graft is taken from the antecubital fossa the crease of skin at the elbow joint or the inner side of the upper arm.
Contraatura skin on the inner side of the upper arm is thin and has enough skin to supply a full-thickness graft. The donor site can be closed with a direct suture. The graft is sutured to the skin surrounding the wound. For one week the hand is protected with a dressing. The hand and arm are elevated with a sling. The dressing is then removed and careful mobilization can be started, gradually increasing in intensity.
Segmental fasciectomy involves excising part fupuytren of the contracted cord so that it congratura or no longer contracts the finger. It is less invasive than the limited fasciectomy, because not all the diseased tissue is excised and the skin incisions contratra smaller. The person is placed under regional anesthesia and a surgical tourniquet is used.
The skin is opened with small curved incisions over the diseased tissue. If necessary, incisions are made in the fingers. The cords are placed under maximum tension while they are cut. A scalpel is used to separate the tissues. They wear an extension splint for two to three weeks, except during physical therapy.
The same procedure is used in the segmental fasciectomy with cellulose implant. After the excision and a careful hemostasisthe cellulose implant is placed in a single layer in between the remaining parts of the cord. After surgery people wear a light pressure dressing for four days, followed by an extension splint. The splint is worn continuously during nighttime for eight weeks. During the first weeks after surgery the splint may be worn during daytime.
Studies have been conducted for percutaneous release, extensive percutaneous aponeurotomy with lipografting and collagenase. These treatments show promise. Needle aponeurotomy is a minimally-invasive technique where the cords are weakened through the insertion and manipulation of a small needle. The cord is sectioned at as many levels as possible in the palm and fingers, depending on the location and extent of the disease, using a gauge needle mounted on a 10 ml syringe.
After the treatment a small dressing is applied for 24 hours, after which people are able to use their hands normally. No splints or physiotherapy are given. The advantage of needle aponeurotomy is the minimal intervention without incision done in the office under local anesthesia and the very rapid return to normal activities without need for rehabilitation, but the nodules may resume growing.
A comprehensive review of the results of needle aponeurotomy in 1, fingers was performed by Gary M. Minimal followup was 3 years.
When a comparison was performed between people aged 55 years and older versus under 55 years, there was conyratura statistically significant difference at both MP and PIP joints, with greater correction maintained in the older group.
Gender differences were not statistically significant.
Complications were rare except for skin tears, which occurred in 3. This study showed that NA is a safe procedure that can be performed in an outpatient setting.
The complication rate was low, but recurrences were frequent in younger people and for PIP contractures. A technique introduced in is extensive percutaneous aponeurotomy with lipografting.
The difference contratra the percutaneous needle fasciotomy is that the cord is cut at many places. The cord is also separated from the skin to make duluytren for the lipograft that is taken from the abdomen or ipsilateral flank.
Intervenção da Terapia Ocupacional na Contratura de Dupuytre by Amanda Ferreira on Prezi
The fat graft results in supple skin. Before the aponeurotomy, a liposuction is done to the abdomen and ipsilateral flank to dupuyttren the lipograft. The digits are placed under maximal extension tension using a firm lead hand retractor. The surgeon makes multiple palmar puncture wounds with small nicks. The tension on the cords is crucial, because tight constricting bands are most susceptible to be cut and torn by the small nicks, whereas the relatively loose neurovascular structures are spared.
After the cord is completely cut and separated from the skin the lipograft is injected under the skin.
A total of about 5 to 10 ml is injected per ray. After the treatment the person wears an extension splint for 5 to 7 days. Thereafter the person returns to normal activities and is advised to use a night splint for up to 20 weeks.
Clostridial collagenase injections have been found to be more effective than placebo. In a MCP joint contratua the needle must be placed at the point of maximum bowstringing of the palpable cord.
The needle is placed vertically on the bowstring. The collagenase is distributed contraturz three injection points. After 24 hours the person returns for passive digital extension to rupture the cord.
Moderate pressure for 10—20 contraturx ruptures the cord. Radiation therapy has been used mostly for early stage disease, but is unproven.
Several alternate therapies such as vitamin E treatment, have been studied, although without control groups. Most doctors do not value those treatments. Laser treatment using red and infrared at low power was informally discussed in at an International Dupuytren Society forum,  as of which time little or no formal evaluation of the techniques had been completed.
File:Morbus dupuytren fcm.jpg
Only anecdotal evidence supports dupuytern compounds such as vitamin E. The term diathesis relates to certain features of Dupuytren’s disease and indicates an aggressive course of disease.
They concluded that presence of diathesis can predict recurrence and extension.