Fróðskaparrit - 01.01.1965, Blaðsíða 106

114
Dupuytrens Contracture
Symptoms.
The first sign is the appearence of a small hard nodule in
the palmar fascia followed by a progressive flexion contrac-
ture, most commonly of the ring finger.
The nodule enlarges to become a cord like band of contracted
fascia and the overlying skin becomes puckered and bound to
the contracted fascia. The patient occasionally complains of
aching although actual pain is uncommon. Paraesthesia as a re-
sult of the distortion of the digital nerves by the thickening
bands may appear rarely.
The affected fingers are flexed at the metacarpo-phalangeal
joints and proximal interphalangeal joints and extended at
the terminal interphalangeal joints.
The flexion of the fingers is due to the contracture of the
prolongations of the palmar fascia to the digit. These bands
do not extend as far as the terminal phalangs so they remain
extended.
Treatment.
A variety of conservative methods have been tried including
cortisone and vitamin E. (Steinberg 1946), without benefit to
the patient.
Operation is the only procedure to influence the rate of
progress. It is the only weapon to relieve contracture and
prevent permanent fixation of the joints and crippling.
The surgery (Bunnell 1944, Einarson 1946) of Dupuytrens
contracture has ranged from a conservative multiple subcu-
taneous fasciotomy to the ultraradical fasciectomy. It is of
great importance to consider the age of the patient in relation
to the expectation of life and in relation to his work.
The operation is not curative. It only relieves existing con-
tracture for a varying period of time.
An important feature of the operation is the management of
the overlying skin which is usually adherent to the contracted
band of fascia. In severe cases skin grafting may be necessary
for closure of the operation wounds.