Abstract
Purpose Analysis of the severity and staging of pathomorphological changes in the arteries of palmar aponeurosis in patients with Dupuytren's contracture of different age groups Materials and methods Analysis of case records of patients younger than 50 years old (n = 19, group 1), from 50 to 65 years old (n = 60, group 2) and over 65 years old (n = 32, group 3). Light microscopy of paraffin sections of palmar aponeurosis fragments resected in partial fasciectomy and histomorphometry of palmar aponeurosis arteries of three calibers: small (outer diameter less than 150 microns), medium (150–300 microns), large (more than 300 microns). Control samples – fragments of the aponeurosis of three patients younger than 50 years old with hand injuries. Results Groups 1–3 arecomparable in terms of fibromatosis duration, frequency of lesions in both hands, and the number of fingers with impaired function, but in group 3 the frequency of contractures in advanced stages and cardiovascular diseases was higher (p less 0.05). In arteries of small caliber, obliterating lesions and signs of expansive remodeling were also encountered; in arteries of medium caliber, expansive remodeling prevailed; in arteries of large caliber, constrictive remodeling was expressed. Discussion The types of remodeling identified were found in all age groups. Based on the results of the study and the data obtained earlier, 6 stages of pathomorphological changes in the vessels of the palmar aponeurosis were identified in Dupuytren's contracture. Conclusion Dupuytren's contracture refers to diseases mediated by vascular remodeling, affecting mainly the arterial bed, the severity and staging of which does not depend on the age of a patient
Highlights
IntroductionNodular and fibrous thickening of the bands of the palmar aponeurosis extends to the fingers, may cause limitation of their extension, and persistent flexion deformities of the hand which impair daily activity and professional skills [1]
Dupuytren's contracture refers to superficial fascial fibromatosis
The results of the study and the data that we obtained to the skin with a diameter of 0.2 to 0.6 mm and earlier [11, 12, 13] allow us to trace six stages of arterioles supplying the aponeurosis with a diameter changes in the vessels of the palmar aponeurosis in the of 0.025 to 0.040 mm
Summary
Nodular and fibrous thickening of the bands of the palmar aponeurosis extends to the fingers, may cause limitation of their extension, and persistent flexion deformities of the hand which impair daily activity and professional skills [1]. Various minimally invasive and open surgeries aimed at destruction or removal of pathological foci and correction of deformations improve the function and esthetic appearance of the hand but do not prevent relapse of the disease [2]. Re-operations are technically difficult even for experienced surgeons, and the risk of complications increases [3]. The effectiveness of all currently known methods of conservative treatment of the disease remains unproven [4], but there is a great need for etiopathogenetic therapy of fibromatosis, which would prevent its progression at the initial stage or prevent relapse in patients who were operated. The role of myofibroblasts, growth factors and cytokines, matrix metalloproteinases, free radicals, sex hormones, changes in gene expression and mechanical stimulation in the development of fibromatosis has been intensively studied over the past decades [5], but the etiology of the disease remains undetermined
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