El Melegy, N., Shoukr, T., Khedr, M., Sdaka, M. (2024). Evaluation of the Outcome of Combining Skin Excision with Limited Fasciectomy in the Treatment of Dupuytren’s Disease and its Histopathological Assessment. The Egyptian Journal of Plastic and Reconstructive Surgery, 48(4), 273-279. doi: 10.21608/ejprs.2024.385101
Nader El Melegy; Tarek Shoukr; Mohamed Khedr; Mohamed Saad Sdaka. "Evaluation of the Outcome of Combining Skin Excision with Limited Fasciectomy in the Treatment of Dupuytren’s Disease and its Histopathological Assessment". The Egyptian Journal of Plastic and Reconstructive Surgery, 48, 4, 2024, 273-279. doi: 10.21608/ejprs.2024.385101
El Melegy, N., Shoukr, T., Khedr, M., Sdaka, M. (2024). 'Evaluation of the Outcome of Combining Skin Excision with Limited Fasciectomy in the Treatment of Dupuytren’s Disease and its Histopathological Assessment', The Egyptian Journal of Plastic and Reconstructive Surgery, 48(4), pp. 273-279. doi: 10.21608/ejprs.2024.385101
El Melegy, N., Shoukr, T., Khedr, M., Sdaka, M. Evaluation of the Outcome of Combining Skin Excision with Limited Fasciectomy in the Treatment of Dupuytren’s Disease and its Histopathological Assessment. The Egyptian Journal of Plastic and Reconstructive Surgery, 2024; 48(4): 273-279. doi: 10.21608/ejprs.2024.385101
Evaluation of the Outcome of Combining Skin Excision with Limited Fasciectomy in the Treatment of Dupuytren’s Disease and its Histopathological Assessment
The Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Tanta University
Abstract
Background: The palmar aponeurosis is extremely adherent to the skin superficial to it. Many pretendinous coarse fibers enter the dermis at an angle in the whole palm, not only at the palmar creases. It is difficult to distinguish whether Dupuytren’s disease (DD) starts in the dermis or the palmar aponeurosis since the skin adheres so closely to the palmar fascia. Objectives: In this work, we investigate the clinical and histological origin of DD, as well as its impact on disease management. Patients and Methods: A prospective clinical study was conducted on 47 patients, 42 males and 5 females, who presented with Dupuytren’s contracture (29 cases were bilateral and 18 were unilateral) between April 2012 and September 2020. We surgically removed all the diseased tissue and cords together with 2-3 mm of the adherent overlying skin, and then the excised tissue was submitted to histopathological examination. Results: All our specimens showed chronic inflammatory skin lesions with hyperkeratotic epidermal covering and dermal infiltration with aggregates of chronic inflammatory cells, mainly lymphocytes and plasma cells, as well as proliferated vascular spaces and fibrous stroma. Clinical satisfaction was excellent in 67 (88.2%) hands, good in six (7.8%) hands, fair in three (4%) hands, and there were no poor results. We had no recurrence in any of our cases after an average follow-up < br />period of 4.2 years. Conclusions: DD is a chronic inflammatory disease that affects both the palmar fascia and skin, as we have seen histologically and surgically. The adhering skin and accompanying cord must be removed for a considerable reduction in recurrence. Whether it originates from fascia or skin, needs further investigation.
Ruettermann M., Hermann R.M., Khatib-Chahidi K. and Werker P.M.N.: Dupuytren’s Disease-Etiology and Treatment. Deutsches Arzteblatt international, 118 (46): 781-8, 2021. 2- Eftimie G. and Eftimie R.: Quantitative predictive approaches for Dupuytren disease: A brief review and future perspectives. Mathematical Biosciences and Engineering, 19 (3): 2876-95, 2022. 3- Stecco C., Macchi V., Barbieri A., Tiengo C., Porzionato A. and De Caro R.: Hand fasciae innervation: The palmar aponeurosis. 31 (5): 677-83, 2018. 4- Warren R.F.: The pathology of Dupuytren’s contracture. British Journal of Plastic Surgery, 6: 224-30, 1953. 5- Wang L. and Zhu H.: Clonal analysis of palmar fibromatosis: A study whether palmar fibromatosis is a real tumor. Journal of Translational Medicine, 4: 21, 2006. Egypt, J. Plast. Reconstr. Surg., October 2024 279 6- Layton T.B., Williams L. and Nanchahal J.: Dupuytren’s disease: A localised and accessible human fibrotic disorder. Trends in Molecular Medicine, 29 (3): 218-27, 2023. 7- Layton T. and Nanchahal J.: Recent advances in the understanding of Dupuytren’s disease. F1000 Research, 8, 2019. 8- van den Berge B.A., Omar F.M.A., Werker P.M.N., Zhan Z., van den Heuvel E.R. and Broekstra D.C.: Treatment durability of limited fasciectomy vs. percutaneous needle fasciotomy for Dupuytren’s disease. Plastic and Reconstructive Surgery, 2024. 9- Alser O., Craig R.S., Lane J.C.E., et al.: Serious complications and risk of re-operation after Dupuytren’s disease surgery: a population-based cohort study of 121,488 patients in England. Scientific Reports, 10 (1): 16520, 2020. 10- Hueston J.T.: Digital Wolfe grafts in recurrent Dupuytren’s contracture. Plast Reconstr Surg Transplant Bull, 29: 342- 4, 1962. 11- Gonzalez R.I.: The use of skin grafts in the treatment of Dupuytren’s contracture. Hand Clinics, 1 (4): 641-7, 1985. 12- Searle A.E. and Logan A.M.: A mid-term review of the results of dermofasciectomy for Dupuytren’s disease. Annales de chirurgie de la main et du membre superieur : organe officiel des societes de chirurgie de la main = Annals of hand and upper limb surgery, 11 (5): 375-80, 1992. 13- Trigg S.D.J.Y.o.O.: Does a ‘firebreak’ full-thickness skin graft prevent recurrence after surgery for Dupuytren’s contracture?: A prospective, randomised trial, 182-3, 2010. 14- McCann B.G., Logan A., Belcher H., Warn A. and Warn R.M.: The presence of myofibroblasts in the dermis of patients with Dupuytren’s contracture. A possible source for recurrence. Journal of hand surgery (Edinburgh, Scotland), 18 (5): 656-61, 1993. 15- Abe Y., Rokkaku T., Ofuchi S., Tokunaga S., Takahashi K. and Moriya H.: An objective method to evaluate the risk of recurrence and extension of Dupuytren’s disease. Journal of hand surgery (Edinburgh, Scotland), 29 (5): 427-30, 2004. 16- Armstrong J., Hurren J. and Logan A.: Dermofasciectomy in the management of Dupuytren’s disease. The Journal of bone and joint surgery British volume, 82: 90-4, 2000. 17- Ketchum L.D.: The use of the full thickness skin graft in Dupuytren’s contracture. Hand Clinics, 7 (4): 731-41; discussion 43, 1991. 18- Chen W., Zhou H., Pan Z.J., Chen J.S. and Wang L.: The role of skin and subcutaneous tissues in Dupuytren’s contracture: An electron microscopic observation. Orthopaedic Surgery, 1 (3): 216-21, 2009. 19- Wade R., Igali L. and Figus A.: Skin involvement in Dupuytren’s disease. The Journal of hand surgery, European volume, 41, 2015. 20- Hueston J.T.: Dupuytren’s contracture. In: Jupiter J., ed. Flynn’s Hand Surgery, 4th edn. Baltimore, MD: Williams and Wilkins, 1991; 1879. 21- Hoopes J.E., Jabaley M.E., Su C.-T., Wilgis E.F.S. and Im M.J.C.: Enzymes of glucose metabolism in palmar fascia and Dupuytren’s contracture. The Journal of Hand Surgery, 2 (1): 62-5, 1977. 22- Denkler K.A., Park K.M. and Alser O.: Treatment Options for Dupuytren’s Disease: Tips and Tricks. Plastic and reconstructive surgery Global Open, 10 (1): e4046, 2022. 23- Hall P.N., Fitzgerald A., Sterne G.D. and Logan A.M.: Skin replacement in Dupuytren’s disease. Journal of hand surgery (Edinburgh, Scotland), 22 (2): 193-7, 1997. 24- Turesson C.: The Role of Hand Therapy in Dupuytren Disease. Hand Clinics, 34 (3): 395-401, 20