Emerging Concept of Dupuytren’s Disease

Dupuytren’s disease is a disorder of fibroproliferative condition causing thickened and contracted of the palmar fascia. The pathophysiology behind this disease is complex and multifactorial. Some major factors are genetic predisposition, inflammatory response, trauma, comorbidities, and environmental factors. The treatment options for Dupuytren’s disease are divided into non-surgical and surgical management. Needle fasciotomy and fasciectomy are some of the most common surgical procedures chosen. Novel non-surgical treatment option as the recent advance in the treatment of the disease is the injection of collagenase Clostridium histolyticum (CCH). One of the pitfalls of Dupuytren’s management is the high possibility of the disease’s recurrence along with some other post-intervention complications. Rehabilitation following the interventions is needed to manage the maximum range of motion and curtail the inflammatory response after the cord disruption. Keywords: Dupuytren’s disease, clostridium histolyticum, fasciectomy.

Comparative Clinical and Pathomorphological Characteristics of Dupuytren’s Contracture in Men and Women

Background. The data available in the literature on the features of the clinical course and functional prognosis of Dupuytren`s disease in women is contradictory, there are no data on comparative pathomorphological studies of palmar fibromatosis in men and women.The aim of the study was to identify possible differences in the clinical and pathomorphological characteristics of Dupuytren`s disease in men and women.Materials and Methods. 228 cases of men and 39 women (6:1) who underwent fasciectomy in 2013–2019 period were analyzed. Histomorphometry of paraffin sections of the patient`s palmar fascia specimens of 24 men and 24 women was performed.Results. Men ranged in age from 26 to 83, the median age is 3 years more in women (p<0.001), but the median age of Dupuytren`s disease debut is 2 years less in women (p<0.001). The frequency of contractures of the 3rd–4th degree was 35.9% in the group of women and 65% in the group of men (p<0.001). In the group of women the frequency of both hands involvement is 15.2% higher, I–III fingers involvement is 8.7% higher, recurrent contracture is 11.1% higher (p<0.1). Histomorphometric analysis of the patient`s palmar fascia specimens showed that women compared to men had 10.23% less adipose tissue (p<0.001), 7.87% less dense connective tissue (p<0.05), but the proportion of hyperplastic connective tissue was 20.31% higher.Conclusion. Dupuytren`s disease is less common in women, than men. Women seek surgical treatment earlier than men. The tendency to functional limitations intensification and the risk of recurrence in women is associated with higher expression of hyperplastic changes in the fascial structures of the hand.

Dupuytren’s contracture treated with botulinum toxin A injection

Dupuytren’s contracture is a condition in which fibromatosis of the palmar and digital fascia can lead to painful contractures of the hand. Common conservative treatments are of limited efficacy, while invasive options have risk of adverse effects. A 57-year-old female presented with chronic, bilateral hand pain secondary to Dupuytren’s contractures. Traditional conservative treatments did not provide relief. She received a series of three botulinum toxin A injections into the palmar fascia of both hands, resulting in four months of improved hand function and pain relief. This case presents a novel treatment for Dupuytren’s contracture using botulinum toxin injection. Botulinum toxin has inhibitory effects on the neuromuscular junction and pain signaling pathways to relax muscles and reduce pain. We believe its action on this patient’s intrinsic hand muscles resulted in her improved hand function. Botulinum toxin injection can be considered as a treatment option for Dupuytren’s contracture.

Limited fasciotomy in dupuytren contracture: a case report

Dupuytren's disease is a benign fibroproliferative disorder usually isolated affects the palmar fascia. The condition usually has a progressive course, from the appearance of a nodule, to the formation of a fibrous cord which pulls the finger in a flexion posture. Management from dupuytren's disease has developed, from conservatifly, surgery, and minimal invasive. One of the conventional treatments that can be done is fasciotomy. A man, 72 years old, an Australian patient with Dupuytren's disease that affects his 4th MCP joint. From the history it was found that the complaint had been felt since 8 years ago. Patients were do limited fasciotomy and get recovered his hand function with good result. Dupuytren's disease is a disorder of the palmar and digital fascia that can decrease the function of patient hands. Many therapies have been developed for the treatment of this disease. From conventional treatments such as fasciotomy, to minimal invasive such as the injection of clostridium histolyticum collagenase. All of these therapies give different results and side effects. We would like to say that conventional management, especially limited fasciotomy, is still a good choice in view of the return of hand function and the minimum side effects. Limited fasciotomy gives good results, fast recovery of hand function, with minimal side effects.

The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis

Background The Dupuytren disease is a benign fibroproliferative disorder that leads to the formation of the collagen knots and fibres in the palmar fascia. The previous studies reveal different levels of Dupuytren’s prevalence worldwide; hence, this study uses meta-analysis to approximate the prevalence of Dupuytren globally. Methods In this study, systematic review and meta-analysis have been conducted on the previous studies focused on the prevalence of the Dupuytren disease. The search keywords were Prevalence, Prevalent, Epidemiology, Dupuytren Contracture, Dupuytren and Incidence. Subsequently, SID, MagIran, ScienceDirect, Embase, Scopus, PubMed and Web of Science databases and Google Scholar search engine were searched without a lower time limit and until June 2020. In order to analyse reliable studies, the stochastic effects model was used and the I2 index was applied to test the heterogeneity of the selected studies. Data analysis was performed within the Comprehensive Meta-Analysis Software version 2.0. Results By evaluating 85 studies (10 in Asia, 56 in Europe, 2 in Africa and 17 studies in America) with a total sample size of 6628506 individuals, the prevalence of Dupuytren disease in the world is found as 8.2% (95% CI 5.7–11.7%). The highest prevalence rate is reported in Africa with 17.2% (95% CI 13–22.3%). According to the subgroup analysis, in terms of underlying diseases, the highest prevalence was obtained in patients with type 1 diabetes with 34.1% (95% CI 25–44.6%). The results of meta-regression revealed a decreasing trend in the prevalence of Dupuytren disease by increasing the sample size and the research year (P < 0.05). Conclusion The results of this study show that the prevalence of Dupuytren disease is particularly higher in alcoholic patients with diabetes. Therefore, the officials of the World Health Organization should design measures for the prevention and treatment of this disease.

Active synthesis of collagen (I) homotrimer and matrisomal proteins in Dupuytren’s fibrosis

Dupuytren’s disease is a common fibroproliferative disease of the palmar fascia of the hand with severe cases treated surgically. The rate of disease recurrence following treatment is high and a continual production of matrisomal proteins could lead to disease recurrence. There is no animal model for Dupuytren’s disease, but analysis of the surgically excised tissue provides an accessible means to study the mechanisms of human tissue fibrosis. Here we sought to determine how new synthesis and the composition of matrisomal proteins in Dupuytren’s differs from normal palmar fascia samples, using metabolic labelling approaches and proteomics. Model non-fibrotic, but fibrous connective tissues, equine flexor tendon and canine cranial cruciate ligament, were used to analyse active collagen-1 protein synthesis in development, ageing and degenerative disease, where it was restricted to early development and ruptured tissue. Dupuytren’s tissue was shown to actively synthesise type I collagen, a proportion of which comprised abnormal collagen (I) homotrimer (mean 14.3% ± 14.4), as well as fibronectin, matrix metalloproteinases (MMP2, MMP3) and their inhibitors; Tissue Inhibitor of Metalloproteinases 2 (TIMP2). Insulin-Like Growth Factor Binding Protein 7 (IGFBP7) was actively synthesised by Dupuytren’s as well as control tissue. Label-free analysis implicated the TGFβ pathway in the matrisomal profile of Dupuytren’s tissue whilst myocilin, a Wnt-pathway regulator, was noticeably more abundant in control samples. No collagen (I) neopeptides representing the major collagenase cleavage site were identified, however periostin neopeptides were abundant in Dupuytren’s tissue and gelatin neopeptides in both tissue types. Synthesis of MMP-resistant collagen-1 homotrimer, together with altered TGFβ and Wnt signalling environments, could contribute to the persistence of the fibrotic tissue and disease recurrence following treatment.

An SNP variant MT1-MMP with a defect in its collagenolytic activity confers the fibrotic phenotype of Dupuytren’s Disease

Dupuytren’s Disease (DD) is a common fibroproliferative disease of the palmar fascia. We previously identified a strong association with a non-synonymous variant (rs1042704, pD273N) in MMP14 (encoding MT1-MMP). We investigated the functional consequences of this variant, and demonstrated that the variant MT1-MMP (MT1-N273) exhibits only 17% of cell surface collagenolytic activity compared to the ancestral enzyme (MT1-D273). Cells expressing both MT1-D273 and MT1-N273 in a 1:1 ratio, mimicking the heterozygous state, possess 38% of the collagenolytic activity compared to the cells expressing MT1-D273, suggesting that MT1-N273 acts in a dominant negative manner. Consistent with this hypothesis, patient-derived DD myofibroblasts expressing MT1-N273 demonstrated around 30% of full collagenolytic activity regardless of the heterozygous or homozygous state. 3D-molecular envelope modelling using small angle X-ray scattering demonstrated altered positioning of the catalytic domain within dimeric molecules. Taken together, our data suggest that rs1042704 directly contributes to the fibrotic phenotype of DD.

A Case with Palmar Fibromatosis with Four Extremity Fibromatosis: Case Report

Palmar fibromatosis (Dupuytren contracture) is the nodule formed on the palmar face of the hand and the contracture of the palmar fascia. It is a clinical disease that causes loss of function resulting in retraction and contracture of the flexor tendons of the hand. Here we summarize a case with a Dupuytren contracture affecting the four extremities and its treatment.

Perforator Flap Based Technique for the Treatment of Dupuytren's Contracture

Background: Perforator flap based technique was used in treating Dupuytren’s Contracture in a cohort of 48 patients. This perforator based on the ulnar palmar digital artery originates from the superficial palmar arch and supplies the hypothenar area. Methods: A curved incision that exposes the diseased palmar fascia was made in middle to distal palm lateral to the hypothenar eminence beginning 20mm distal to the distal wrist crease up to the heel of the palm. An additional incision from the arch of the curved incision extends into the middle phalanx for exposure of the digital cord. The perforator flap was raised along the hypothenar region in 53 hands of 48 patients, nine females and 39 males and their ages at the time of surgery averaged 56 years. The Tubiana classification illustrates the extent of the disease in our patients’ population with no distal interphalangeal joint involvement. Results: Of the 48 patients, five patients had bilateral hands involvement. Two patients complained of paresthesia in the ring and little fingers after surgery, the symptom had disappeared without further intervention before the latest follow-up. There was no incidence of skin necrosis and delayed healing. Up to date, there has been no reported recurrence. Conclusion: This perforator flap based technique is technically simple and reliable with better exposure and easier removal of all the diseased fascia, making it possible for primary healing without skin necrosis and acceptable for treatment of patients at all stages of the disease.