Clinical and Pathomorphological Analysis of Mechanisms of Progression of Dupuytren’s Contracture

Abstract

INTRODUCTION: The factors and mechanisms of progression and recurrence of the palmar fascial fibromatosis with formation of severe Dupuytrens contracture, remain insufficiently studied.
 AIM: To identify probable mechanisms of progression of the palmar fascial fibromatosis based on the comparative analysis of clinical and morphological characteristics of patients with Dupuytrens contracture of different extent of severity.
 MATERIALS AND METHODS: Objects: medical histories and histological preparations of surgical material of patients with III (group 1, n = 121) and IIIIV (group 2, n = 135) degree Dupuytrens contracture. Methods: clinical, histological, statistical.
 RESULTS: Clinical markers of hereditary predisposition to Dupuytrens disease (the percentage of patients under 50 at the time of onset of the disease and the frequency of involvement of both hands) were comparable in the study groups. The incidence of diseases of the circulatory system was reliably higher in group 2: 57.0% against 41.3% (p 0.01). A prolonged course of the disease ( 8 years) was identified only in half of the patients of group 2. The median of the content of hyperplastic connective tissue in the palmar aponeurosis in patients of groups 1 and 2 was 22.9% and 11.3%, respectively (p 0.001), interquartile range 0%67.8% and 0%56.7%, respectively. In the capillary network and in the intima of larger vessels, CD34-positive endothelium was identified in patients of both groups. Around the blood vessels supplying fibromatous nodules and cords, cells expressing CD34 were found. Thickness of adventitia and Kernogan index in the arteries perforating the palmar aponeurosis, were higher in group 2.
 CONCLUSION: A higher frequency of comorbid diseases of the circulatory system, more evident thickening of adventitia of arteries perforating the palmar aponeurosis, and reduction of their throughput capacity in patients with severe Dupuytrens contractures indicate the significance of systemic and regional vasogenic mechanisms of progression of the palmar fascial fibromatosis. The content of hyperplastic connective tissue (histological predictor of recurrence) varies individually with each degree of contracture.