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The Egyptian Journal of Plastic and Reconstructive Surgery
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Volume Volume 49 (2025)
Volume Volume 48 (2024)
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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

Article 5, Volume 48, Issue 4, October 2024, Page 273-279  XML PDF (1000.22 K)
Document Type: Original Article
DOI: 10.21608/ejprs.2024.385101
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Authors
Nader El Melegy* ; Tarek Shoukr* ; Mohamed Khedr; Mohamed Saad Sdaka
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.
Keywords
Dupuytren Disease; Treatment; Origin; Dermis
Main Subjects
Hand and Upper Limb Surgery'
References
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

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