Dupuytren's disease
Masmejean, E.; Tordjman, D.
La Revue du Praticien 63(9): 1263-1267
2013
ISSN/ISBN: 0035-2640 PMID: 24422298 Document Number: 670766
Dupuytren's disease, first described in 1831 by G. Dupuytren, is a mysterious retractile fibrosis of the palmodigital aponeurosis. Its etiology remains unclear despite various risk factors identified including genetics factors. Most patients are middle age males and have Caucasian's origin (northern Europe). Among risk factors, diabetes is the most frequent associated disease. Characteristic clinical signs are the palmar nodules, ombilications and cords causing finger contractures. There is various clinical features with also ectopic signs: Ledderhose's disease, Lapeyronie's disease and dorsal pads. There is no conservative treatment. The treatment is justified when the patient can't put his hand flat on the table (Hueston's test). Therapeutic strategy depends on the extent and level of retractions. Needle fasciotomy is preferred for palmar forms. Surgery (fasciectomy) is the standard procedure for digitopalmar forms because of complexity of band's anatomy and its proximity with the neurovascular bundle. Enzymatic fasciotomy using collagenase injections have been recently developped. Published results are hopeful and assessment in Europe is underway. Anyhow the used technique, recurrence is frequent and can be treated by dermofasciectomy. Palliative surgery, as arthrodesis, can be necessary in case of recurrency.