FDA approves Collagenase for Dupuytren’s
Collagenase (Xiaflex) has been approved by the FDA for treatment of Dupuytren’s contracture, after years of intensive laboratory and clinical trials. Collagenase enzymatic fasciotomy is more similar to needle fasciotomy than to either open fasciotomy or fasciectomy in terms of rapid recovery and low complication rate. Compared to needle release, collagenase enzymatic fasciotomy should eventually […]
Dupuytren’s Genes
The hunt is on for the genetic basis of Dupuytren’s. A interesting analysis of the chromosome patterns found in Dupuytren’s tissue found a variety of genetic abnormalities and the unexpected finding that these variations were not found in the skin but were seen in areas of palmar fascia not usually involved with Dupuytren’s. (full text: […]
Luck and Dupuytren’s
Needle aponeurotomy for Dupuytren’s is not that new. It’s a new twist on the very first operation described for Dupuytren’s, percutaneous fasciotomy, which was performed by Cooper years before Dupuytren’s famous presentation. Adams wrote extensively about his results with percutaneous fasciotomy for Dupuytren’s in the late 1800s. Before Lermusiaux began using a needle for percutaneous […]
ß Catenin, Transforming Factor ß and Dupuytren’s
The physical changes associated with Dupuytren’s are similar to the process that heals open wounds through contraction and collagen production. Thanks to sophisticated laboratory research, the molecular controls for this process are beginning to be understood. In Dupuytren, two controls are ß Catenin and Transforming Factor ß. ß-catenin is a protein that is part of […]
Needle Aponeurotomy for Dupuytren’s
Needle aponeurotomy for Dupuytren’s contracture is a type of fasciotomy performed under local anesthesia. Compared to fasciectomy, it is less of an ordeal for the patient in terms of both procedure and recovery and has a lower complication rate. This report (full text: https://dupuytrens.org/DupPDFs/2008_Cheng_1610.pdf) reviews one group’s experience with needle aponeurotomy.
Dupuytren’s and Transforming Factor Beta Genetics
What is the initial abnormality which ultimately results in Dupuytren’s? Because biologic systems are guided by tiny triggers which start a cascading series of events, tiny differences can have large effects, and the hunt is sometimes for tiny differences early in the game. Transforming Factor Beta One (TGF-ß1) is one of the starting players in […]
Dermofasciectomy reconsidered
There are three mechanical approaches for Dupuytren’s. In order of both increasing problems and long term effectiveness, these are: fasciotomy (cut fascia); fasciectomy (remove fascia); dermofasciectomy (remove both skin and fascia). The popularity of dermofasciectomy and skin grafting has been limited by concerns regarding complications of wound healing and loss of flexion. Some of these […]
Matrix Metalloproteinases and Dupuytren’s
What are matrix metalloproteinases and how are they linked to Dupuytren’s? Matrix Metalloproteinases (MMPs) are naturally occuring enzymes whose name describes them: they are found outside cells in the extracellular matrix, their molecular makeup includes a metal (Zinc) and they break down proteins. Human collagenase, which breaks down collagen, is in this group, and Dupuytren’s […]
Cortisone shots for Dupuytren’s nodules
Cortisone injections have been used for many years as an early treatment for Dupuytren’s in the nodular stage of involvement. This approach is based on clinical experience, but what is the actual biology? It may have to do with the finding that tissue matrix as well as the blood vessel cells in Dupuytren’s nodules have […]
Feedback Loops in Dupuytren’s
The best hope for finding a medical cure for Dupuytren’s and other fibrotic conditions is through a better understanding of abnormal cell signalling feedback loops regulating fibrosis. Cellular collagen metabolism regulation is not fully understood. Here are a few puzzle pieces. The protein transforming growth factor beta (TGF-ß), among other things, signals myofibroblasts to produce […]
