PATHOMORPHOLOGIC CHARACTERISTICS OF PALMAR APONEUROSIS IN PATIENTS WITH DUPUYTREN’S CONTRACTURE AND VIRAL HEPATITIS

Objective. To establish pathomorphologic peculiarities of palmar aponeurosis in the patients with Dupuytren’s contracture and concomitant virus hepatitis B and C. Methods. The data analysis of histomorphometric studies of the operation samples of 122 patients with Dupuytren’s contracture («Control» group, n=100) and Dupuytren’s contracture with virus hepatitis B and C («Hepatitis» group, n=22) were analyzed. Results. In patients of the «Hepatitis» group, the content of adiposed tissue in the palmar aponeurosis was 40.9% less (p <0.01) than in the «Control» group, and the content of dense connective tissue was 18.9% higher (p <0, 05). In all patients, arteries with the diameter up to 150 µm prevailed in the palmar aponeurosis, but in the «Hepatitis» group their percentage was reduced by 20%, with higher proportions of vessels with the diameter of 150-450 µm and the absence or recalibration of the largest arteries. In the «Control» group, the arteries had diameters from 50 to 660 µm, in the «Hepatitis» group they did not exceed 370 µm. Vessels less than 300 µm in diameter in both groups had comparable values of the Kernogan’s index. Arteries with a diameter of more than 300 microns in the «Hepatitis» group had higher values of the Kernogan’s index, which indicated a low conductance capacity compared to the vessels in the «Control» group. Most of the nerve trunks of the palmar aponeurosis in the patients of «Hepatitis» group showed signs of necrobiotic changes, i.e. fibrotic or swollen perineurium, withinflammatory cell infiltration, sometimes lost lamellar structure, and nerve fibers with signs of Wallerian degeneration. Conclusion. Obtained histomorphometric data of the tissue composition of palmar fascial fibromatosis, less amount of adiposed tissue and higher amount of dense connective one and more pronounced disorder of hemodynamics and innervation of the palmar aponeurosis in the group with concomitant virus hepatitis indicate significant effect of the liver pathology on the progression of the disease. What this paper adds For the first time, the pathomorphological features of the palmar aponeurosis have been studied in 122 patients with Dupuytren’s contracture and concomitant viral hepatitis B and C.It has been found that in patients with Dupuytren’s contracture and hepatitis in the palmar aponeurosis, the amount of adiposed tissue is reduced and the amount of dense connective tissue is increased; hemodynamic and innervation disorders are more pronounced.

Evaluation of WNT Signaling Pathway Gene Variants WNT7B rs6519955, SFRP4 rs17171229 and RSPO2 rs611744 in Patients with Dupuytren’s Contracture

Dupuytren’s contracture (DC) represents a chronic fibroproliferative pathology of the palmar aponeurosis, which leads to flexion contractures of finger joints and hand disability. In recent decades, the WNT signaling pathway has been revealed to play a significant role in the manifestation and pathogenesis of DC. Our study aimed to evaluate the associations between Dupuytren’s contracture and WNT-related single-nucleotide polymorphisms: Wnt Family Member 7B (WNT7B) rs6519955 (G/T), Secreted Frizzled Related Protein 4 (SFRP4) rs17171229 (C/T) and R-spondin 2 (RSPO2) rs611744 (A/G). We enrolled 216 patients (113 DC cases and 103 healthy controls), and DNA samples were extracted from the peripheral blood. Genotyping of WNT7B rs6519955, SFRP4 rs17171229 and RSPO2 rs611744 was performed using the Real-Time PCR System 7900HT from Applied Biosystems. WNT7B rs6519955 genotype TT carriers were found to possess a higher prevalence of DC (OR = 3.516; CI = 1.624–7.610; p = 0.001), whereas RSPO2 rs611744 genotype GG appears to reduce the likelihood of the manifestation of DC nearly twofold (OR = 0.484, CI = 0.258–0.908, p = 0.024). In conclusion, SNPs WNT7B rs6519955 and RSPO2 rs611744 are associated with the development of Dupuytren’s contracture: WNT7B rs6519955 TT genotype increases the chances by 3.5-fold, and RSPO2 rs611744 genotype GG appears to attenuate the likelihood of the manifestation of DC nearly twofold. Findings of genotype distributions among DC patients and control groups suggest that SFRP4 rs17171229 is not significantly associated with development of the disease.

A study of variations in formation of superficial palmar arch in Nepalese cadavers

Introduction: The superficial palmar arch (SPA) is the main source of arterial supply to the palm. It is an arterial arcade formed mainly by the ulnar artery and is completed by the superficial palmar branch of the radial artery. The study was conducted with objective to study the variations in formation of superficial palmar arch in Nepalese cadaveric hands. Methodology: Two horizontal incisions were made, one at the wrist joint and another incision along the root of fingers. A vertical incision was made from the middle of the wrist to the 3rd metacarpo-phalangeal joint. The skin of the palm and the palmar aponeurosis was reflected. The surrounding adipose tissue was removed to view the superficial palmar arch and its branches. Result: In present study, out of 50 specimens of hands, 64% of superficial palmar arch was formed as normal pattern and in 36% cases it was formed by ulnar artery alone. Normal SPA pattern was seen 63% in male and 66.7% in female i.e. higher percentage in female than in male but it was statistically insignificant (P<0.05). SPA-ulnar artery alone pattern was seen 37% in male and 33.3% in female i.e. higher percentage in male than in female, however it was also statistically insignificant (P<0.05). Conclusion: Normal pattern of SPA observed in Sixty-four percent of Nepalese hands and in thirty-six percent cases it was formed by ulnar artery alone. There was no statistically significant difference in SPA pattern distribution between Nepalese male and female.

Anatomical work-up of an individual with multiple muscular variants on both forearms

Muscular variants of the forearm are common and frequently cause neurovascular compression syndromes, especially when interfering with the compact topography of the carpal tunnel or the Canalis ulnaris. Here, we report on a male body donor with multiple muscular normal variations on both forearms. The two main findings are (1) an accessory variant muscle (AVM) on the right forearm originating from the M. brachioradialis, the distal radius, and the M. flexor pollicis longus. It spanned the wrist beneath the Fascia antebrachia and inserted at the proximal phalanx of the digitus minimus. (2) Moreover, we found a three-headed palmaris longus variant on the left arm with proximal origin tendon and a distal, trifurcated muscle belly, with separated insertions at the palmar aponeurosis, the flexor retinaculum, and, in analogy to the accessory muscle on the contralateral arm, at the base of the proximal phalanx of the digitus minimus. We found a considerable thickening of the left-hand median nerve right before entering the carpal tunnel indicative of a possible chronic compression syndrome adding clinical relevance to this anatomical case. We also discuss the notion that both, the AVM and the contralateral three-headed palmaris variant are developmental descendants of the M. palmaris longus. Additionally, we found a previously not recorded variant of the M. palmaris brevis on the left hand.

Differential Pulley Release in Trigger Finger: A Prospective, Randomized Clinical Trial

Background: The palmar aponeurosis or “A0 pulley” may play a role in trigger finger pathology. This study assesses the involvement of the A0 pulley in patients receiving trigger finger release. Methods: This single-surgeon, prospective, randomized clinical trial was conducted among consenting patients with symptomatic trigger finger. Intraoperative coin toss was used to randomize initial release of either the A0 or A1 pulley. Following release, active flexion and extension of the affected digit were examined. The remaining pulley was then released in sequence, and clinical trigger status was recorded. Results: Thirty fingers from 24 patients were released; 17 fingers received A0 release first, and 13 received A1 release. Following initial A0 release, 8 fingers (47%) demonstrated complete resolution of symptoms, 4 (24%) demonstrated improvement but incomplete resolution of triggering, and 5 (29.4%) demonstrated no improvement. Following initial A1 release, 6 fingers (46%) demonstrated complete resolution, 3 (23%) demonstrated improvement but incomplete resolution of triggering, and 4 (31%) demonstrated no improvement. All patients demonstrated complete resolution after surgical release of both sites. Neither initial A1 release nor initial A0 release was statistically associated with complete, incomplete, or failed symptom resolution. Conclusions: These data implicate the A0 pulley as the primary cause of 31% to 47% of trigger fingers in our study. Although larger trials are needed to validate these results, our study suggests that release of both A0 and A1 pulleys may offer greater symptom resolution than release of the A1 pulley alone.

Results of minimally invasive treatment of scar degeneration of palmar aponeurosis

An analysis of the results of surgical treatment of patients with Dupuytren’s contracture using tactics of minimally invasive percutaneous aponeurotomy and open aponeurectomy is presented. Dupuytren’s contracture (CD) is a chronic disease characterized by cicatricial degeneration of the palmar aponeurosis with a predominant lesion of the working population. The need to quickly restore the function of the upper limb in the postoperative period in patients with CD leads to the need to develop new and modernize the existing minimally invasive tactics of surgical treatment, allowing to minimize the duration of treatment and the risks of various complications.

THE STUDY OF DIELECTRIC HOMOGENEITY OF FIBROTIC-ALTERED “SWIMMING SEPTUM” OF THE HAND AT DUPUITREN DISEASE

The dielectric properties of fibrotic-altered tissues in patients with Dupuytren's contracture were studied using near-field microwave sensing. It was found that fibrotic-altered Palmar aponeurosis has a fairly uniform microwave structure, which allows us to count on the possibility of accurate visualization of its boundaries.

ANATOMICAL MODELING OF FETUS AND NEWBORN PALM STRUCTURES

Numerous anomalies manifested in clinical practice, in most cases, can be explained only on the basis of clarifying the origin and interaction of organs and structures, which over time acquire their characteristic forms, having studied their unusual topography and deeply understanding the corresponding embryonic phenomena. A detailed study of the anatomy of the hand is necessary for a correct under-standing of the pathways of the spread of purulent-inflammatory processes and the development of rational methods of surgical treatment. The prognostication models created to foresee standard morphometric parameters of a palm within a perinatal ontogenesis period are: for the length of a palm = β0+ 0.042 х parietal-calcaneal lengths of a fetus, where β0:= 3.587 during the 4th month of gestation; 5.562 = 5th month; 4.071 = 6th month; 4.840 = 7th month; 6.881 = 8th month; 5.624 = 9th month; 5.448 = 10th month; 5.765 = neonates; for the width of a palm = β0+ 0.038 х parietal-calcaneal length of a fetus, where β0= 2,887 for the 4th month of fetal age; 4.341 = 5th month; 2.638 = 6th month; 3.324 = 7th month; 3.548 = 8th month; 1.714 = 9th month; 1.814 = 10th month; 3.231 = neonates. The proposed models of standard morphometric parameters of a palmar aponeurosis in the perinatal ontogenesis period are the following: for its length – the length of a palmar aponeurosis = β0+ 0.022 х parietal-calcaneal length of a fetus, where β0= 3.531 for the 4th month of the gestational age; 6.532 = 5th month; 6.851 = 6th month; 6.526 = 7th month; 7.583 = 8th month; 7.044 = 9th month; 6.964 = 10th month; 7.968 = neonates; for the width – the width of a palmar aponeurosis = β0+ 0.018 х parietal-calcaneal length of a fetus, where β0= 2.624 within the 4th month of a fetus age; 5.431 = 5th age; 3.701 = 6th age; 4.233 = 7th age; 4.121 = 8th month; 3.602 = 9th age; 3.956 = 10th month; 4.881 = neonates.