Emerging Concept of Dupuytren’s Disease

Dupuytren’s disease is a disorder of fibroproliferative condition causing thickened and contracted of the palmar fascia. The pathophysiology behind this disease is complex and multifactorial. Some major factors are genetic predisposition, inflammatory response, trauma, comorbidities, and environmental factors. The treatment options for Dupuytren’s disease are divided into non-surgical and surgical management. Needle fasciotomy and fasciectomy are some of the most common surgical procedures chosen. Novel non-surgical treatment option as the recent advance in the treatment of the disease is the injection of collagenase Clostridium histolyticum (CCH). One of the pitfalls of Dupuytren’s management is the high possibility of the disease’s recurrence along with some other post-intervention complications. Rehabilitation following the interventions is needed to manage the maximum range of motion and curtail the inflammatory response after the cord disruption. Keywords: Dupuytren’s disease, clostridium histolyticum, fasciectomy.

The association of bariatric surgery and Dupuytren’s disease: a propensity score-matched cohort study

We aimed to assess the association between bariatric surgery and incident Dupuytren’s disease (DD) using propensity score-matched cohort studies among Swedish nationwide healthcare registries. Patients aged 30–79 years who underwent bariatric surgery 2006–2019 were matched on their propensity scores, up to two obese bariatric surgery-free (unexposed) patients. We applied Cox proportional hazard regression to calculate hazard ratios (HR) with 95% confidence intervals (CI) for the risk of DD overall, in subgroups of age, sex, bariatric surgery type and duration of follow-up. Among 34,959 bariatric surgery patients and 54,769 propensity score-matched obese patients, the risk of DD was increased in bariatric surgery patients compared with obese unexposed patients (HR 1.30, 95% CI 1.02–1.65), among women (HR 1.36; 1.00–1.84); those undergoing gastric bypass (HR 1.33; 1.04–1.71) and those with >5 years follow-up (HR 1.63; 1.14–2.34). Our results suggest that substantial weight loss is associated with an increased risk of DD in an obese population. Level of evidence: III

Actual Aspects of Surgical Treatment of Dupuytren's Disease (Literature Review)

Relevance. The variety of manifestations of Dupuytren's disease, caused by the degree of lesions of the palmar aponeurosis, the duration of the disease, the nature of professional activity, and concomitant pathology of patients, has led to the development of numerous surgical techniques with different levels of effectiveness in the acute and long-term periods. A wide discussion of the issues of Dupuytren's disease in the domestic and foreign periodicals, the analysis of treatment methods, complications and rehabilitation indicate the urgency of the problem and the expediency of further research. Objective: a retrospective analysis of the leading literary sources devoted to the surgical treatment of Dupuytren's disease; the definition of modern approaches to surgical tactics and restoration of hand function. Results. The analysis of literature sources showed the advantages of differentiated approaches to the surgical treatment of Dupuytren's disease, depending on the severity of the disease. With mild and moderate lesions, there is a significant increase in needle aponeurectomy. In severe forms, the segmental aponeurectomy technique is preferred over the total one. There is some discrepancy in carrying out surgical mobilization of the proximal interphalangeal joint and the need to achieve a functional position as a result of treatment. The tactics of surgical treatment and rehabilitation of Dupuytren's disease requires an individual approach, taking into account the age and severity of the disease, and tends to spread minimally invasive fasciotomy techniques.