Dupuytren contracture surgery

Palmar palpebral contracture is a hand deformity characterized by all or part of the palpebral membrane due to tissue hypertrophy, contraction, and flexion and contraction of the metacarpophalangeal and proximal interphalangeal joints of the hand. The palmar aponeurosis is a thick layer of the deep fascia of the hand. It is an inverted triangle. The proximal end is connected to the distal side of the transverse ligament of the wrist, and some of the fibers are connected to the longus tendon. The palmar aponeurosis is divided into three parts. The weaker sides are covered on the large and small fishes to form the fish fascia and the small fish fascia. The central part of the metacarpal head is radial and the flexor tendon is in the same direction. The fusion of the tendon sheath of the corresponding finger and the collateral ligament of the metacarpophalangeal joint is called the anterior tibial tract. The palmar surface of the palmar membrane has vertical fibers that are closely connected to the palm skin, especially at the flexion of the palmar flexor. Most of the fibers of the palmar aponeurosis are longitudinal, close to the small part of the metacarpal head and have transverse fibers connected to form a palmar transverse ligament. The palmar aponeurosis extends distally to each finger into three bundles, one for the central bundle and the entire length of the finger, at the center of the palm of the finger, connected to the skin, and the two bundles are connected to the flexor fiber sheath, periosteum and joint capsule. But not to the distal interphalangeal joint. The cause of palmar palpebral contracture is unclear. Skoog pointed out that the disease has a family history and must be hereditary. There are several people in a family or in several generations. Certain diseases such as endocrine disorders, rheumatoid, alcoholism, diabetes, etc. are often accompanied by palmoplantar contracture. Trauma and the disease are not very relevant. The palmar palpebral contracture is mainly a proliferative change of the palmar aponeurosis, connective tissue hyperplasia, the most obvious part is the wrinkles of the skin at the distal palm striate, the local skin gradually loses its original elasticity, becomes thick and tough and The palpebral palpebral membrane is tightly adhered, the fingers are gradually deformed and deformed, and the pathological process is different. The frequently found features are summarized as follows: 1 There is a subdural nodule or cord in the palmar aponeurosis; 2 The subcutaneous interphalangeal joint can have thickened subcutaneous fibrous tissue to form a finger pad (Knuekle pads) (3) There is a fixed plaque on the skin of the palmar aponeurosis at the distal palm of the affected finger; 43% to 5% of the patients may have decidual constriction, ie plantranodule; 5 very few patients It can be combined with the thickening of the corpus cavernoid fascia fiber bundle to cause penile sclerosis. The symptoms of this disease are prominent, and the general diagnosis is not difficult, but it should be differentiated from general scar contracture and congenital multiple joint contracture. Treatment of diseases: deep palm infection in the palm Indication Dupuytren contracture surgery is suitable for: 1. The lesion develops rapidly and has formed dysfunction. 2. In the early cases, the deep tissue changes less frequently, the surgery is easy to expose, and it is feasible to completely remove the lesion to correct the deformity surgery. 3. The contracture deformity is severely accompanied by difficulty in resection of deep tissue contracture, and it is feasible to improve some functions. Surgical procedure Subcutaneous debridement It is a subcutaneous rupture of the palmar aponeurosis, which is simple and destructive, and is suitable for patients with linear constriction of the aponeurosis in the palm. However, patients with a contraction below the distal palm line or in the finger should not use the blind subcutaneous cutting method to avoid injury to the blood vessels and nerves. Intraoperative 11 or 15 surgical blades can be used to penetrate the skin of the small fish parallel, the blade enters between the skin and the contracture band, carefully peel off the skin, separate the adhesion between the two, and then passively straighten the finger, use The blade cuts the contracture band until the flexion of the affected finger is corrected. When cutting the contracture band, do not repeatedly pull the blade to avoid injury to important tissues in the deep. 2. Partial excision of the palmar membrane It is suitable for contracture involving longitudinal fibers and affecting a single finger with proximal interphalangeal joint contracture, or for elderly patients. A Z-shaped or W-shaped incision is feasible, the partially collapsed palmar membrane is removed, and the thickened longitudinal fibers are removed to preserve the transverse fibers of the palmar membrane. 3. Total resection of the palmar membrane That is, all the contracted palmar membranes are removed, including the palmar aponeurosis and the fibers that are perpendicular to the skin, the fiber spacing on both sides of the metacarpal bone, and the central and lateral cords that enter the fingers. Surgery can be performed with transverse or L-shaped incisions along the distal palm. Peel off under the skin, sharply dissect and lift the flap and protect the skin edge. After exposing the entire palmar membrane, cut the proximal end, then clamp the broken end with a vascular clamp, and carefully remove the palmar membrane to the base of the finger with a pointed blade. The displaced nerves and blood vessels are not damaged. The fibrous connective tissue around the vascular bundle and the fibrosis of the flexor tendon should also be removed, but the flexor tendon sheath does not need to be cut or removed. Thickened intermuscular sarcolemma and diaphragmatic membrane should also be removed. Finger lesions can be removed by another incision, and skin conditions are poor for skin grafting or Z-forming. 4. Single finger interception In elderly patients, the index of the small finger is severe, and the effect of resection of the palmar aponeurosis is not good. Single-finger fingering can also be considered.

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