Dupuytren's Disease: Anatomy and Surgical Treatment

McGrouther, Duncan Angus (1988) Dupuytren's Disease: Anatomy and Surgical Treatment. MD thesis, University of Glasgow.

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Abstract

The principal aim of this written account is to describe the evolution of a surgical approach to the treatment of Dupuytren's Disease based on current knowledge of pathogenesis and precise description of the anatomy. The historical record of the life and works of Baron Guillaume Dupuytren, together with those of his contemporaries, pupils and critics have been reviewed to clarify the understanding of the condition at that time and to uncover wisdom which has been forgotten. The disease process is considered by analysis of studies of incidence, aetiological factors, pathology and related fibromatous lesions. Series of dissections of the palm and digits in fresh and preserved cadaveric hands have been performed to establish a new perspective on the micro-anatomy of the normal ligamentous components of the hand. The lesions of Dupuytren's Disease - palmar nodules, pits and cords, distortion of palmar creases and knuckle changes - have been examined by observations of clinical signs and operative dissections. New clinical signs -the "blanching" sign in the palm, and knuckle changes -have been described. A new classification of operative interventions is described according to the approach to a) the skin, b) the fascia and c) the joints. The operative experience and long term results, using an evolution of techniques, have been reviewed in a series of 100 patients. Dupuytren's Disease is viewed as a process akin to wound healing which involves not only the palmar fascia, as described by Dupuytren, but many of the connective tissues of the hand including the dermis of the skin. The distribution of the pathological tissue is not random, but dictated by lines of tension or stress concentrations transmitted through certain anatomical pathways. Movement of the hand may be the stimulus to the propagation of the contracture once it has commenced. Treatment has been found to be generally not curative, but affording only temporary release. A less extensive and more precise operative approach has been developed. The values of minimal surgery and maximal rehabilitation are stressed.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine, Morphology
Date of Award: 1988
Depositing User: Enlighten Team
Unique ID: glathesis:1988-77646
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 14 Jan 2020 11:53
Last Modified: 14 Jan 2020 11:53
URI: http://theses.gla.ac.uk/id/eprint/77646

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