Dupuytren’s Disease : A Concept of Surgical Treatment

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. Front Matter....Pages I-XIII Introduction....Pages 1-3 Dupuytren’s disease—a historical overview....Pages 4-5 Epidemiology....Pages 6-8 Theories concerning etiology and pathogenesis....Pages 9-22 Ground substance and cells of the extracellular matrix....Pages 23-36 Subjective complaints....Pages 37-37 Symptoms of Dupuytren’s contracture....Pages 38-44 Course of Dupuytren’s contracture....Pages 45-45 Anatomy of the palmar fascia (G. M. Rayan)....Pages 46-66 Classification....Pages 67-78 Conservative therapy....Pages 79-82 Surgical goals....Pages 83-83 Surgical indications....Pages 84-104 Selection of surgical techniques....Pages 105-107 Contraindications....Pages 108-108 Informed consent....Pages 109-109 Preoperative work up....Pages 110-110 Instruments....Pages 111-111 Anesthesia and positioning....Pages 112-112 Operative technique....Pages 113-183 Additional measures to improve hand function....Pages 184-195 Postoperative treatment....Pages 196-197 Errors, hazards, and complications....Pages 198-200 Results....Pages 201-206 Conclusions....Pages 207-211 Back Matter....Pages 213-241