Dupuytren’s Disease de Peter Brenner

Dupuytren’s Disease: A Concept of Surgical Treatment

Peter Brenner

H. Millesi

J. Gratzer

B. Twisselmann

H. Schimek

Ghazi M. Rayan

Morbus Dupuytren is particularly widespread among northern Europeans. However, the therapeutic success-rate often leaves much to be desired. A 50% recurrence-rate after surgery indicates that the disease cannot be treated by surgery alone. This book therefore adopts two parallel approaches: emphasis is firstly placed on the systemic character of morbus Dupuytren in context with other connective tissue diseases by a description of the biochemical and molecular-biological changes in the diseased connective tissues; secondly, a diversified picture of the given anatomical facts serves to explain the employment of the various therapeutic approaches. Further, a description is given of the current surgical procedures.

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Cuprins

Introduction Dupuytren's disease – a historical overview Epidemiology • Prevalence of Dupuytren's disease among Caucasians • The incidence of Dupuytren's disease in Germany • Age and Dupuytren's disease • Sex distribution in Dupuytren's disease • Handedness in digitopalmar contracture Theories concerning aetiology and pathogenesis • Association between trauma and Dupuytren's disease • Ectopic fibromatoses • Hepatic cirrhosis and Dupuytren's disease • Alcohol abuse • Nicotine abuse • Epilepsy • The hypothesis of a neurogenic origin of Dupuytren's disease • Hereditary factors • Dupuytren's diathesis • Coincidence of Dupuytren's disease and disorders of the immune system • Dupuytren's disease in diabetes • Vascular disease • Oxygen free radicals and induction of Dupuytren's disease Ground substance and cells of the extracellular matrix • The extracellular matrix • Fibrous proteins • Glucosaminoglycans of the extracellular matrix • Fascial and plasmatic patterns of glycosaminoglycans in Dupuytren's disease • Interactions between collagens, glycosaminoglycans, and fibroblasts Subjective complaints Symptoms of Dupuytren's contracture Course of Dupuytren's contracture Anatomy of the palmar fascia (G M RAYAN) • Development of the palmar fascia • Anatomy of the palmar fascia Classification Conservative treatments Surgical goals Surgical indications • Thoughts on the indication in the nodular and cord stages • Mechanical strains Selection of surgical techniques • Indications for fasciotomy and different forms of fascietomies • Indications for additional measures • Indications for additional simultaneous interventions • Indications in recurrent disease Contraindications Informed consent Preoperative workup Instruments Anaesthesia and positioning Operative technique • Remarks on skin incisions • Approaches to fingers and palm • Excision of the tissueaffected by Dupuytren´s disease • Skin suture Additional measures to improve hand function • Fixed flexion deformity at the interphalangeal joints • Extension methods • Remarks on teno- and arthrolysis • Corrective osteotomy • Arthrodeses • Amputation Postoperative treatment • Follow up treatment after minimal invasive procedures • Postoperative management after partial and total fasciectomy • Specifics of the open palm technique • Aftercare following skin grafts and local flaps • Aims of physical and occupational therapy Errors, hazards and complications • Hematomas • Lesions of the neurovascular bundles • Necrosis of the wound margin • Graft failure • Flap necrosis • Reflex sympathetic dystrophy (algodystrophy) Results • Functional results and recurrence rates • Complications dependingon the surgical technique Conclusions References Subject index

Recenzii

"... Das Buch ist ausserordentlich grosszügig ausgelegt mit sehr schönen Zeichnungen und ebenso schönen Farbaufnahmen. Für den Erfahrenen stellt es ein wunderschönes Repetitorium dar, für den Anfänger eine fast spannende Darstellung dieser wichtigen Handerkrankung und für den handinteressierten Allgemeinpraktiker ein wertvolles, sehr schönes Lexikon ..." swiss surgery 6/2003