Blog
Dupuytren’s and Burns
Dupuytren’s overlaps in some ways with the local excessive scarring which occur after a burn injury. This report documents the development of progressive Dupuytren’s disease developing in a young man after a hand burn, and reviews the conventional teachings regarding Dupuytren’s: https://www.dupuytrens.org/DupPDFs/2008_Balakrishnan_1422.pdf
Gene Expression in Dupuytren’s
If Dupuytren’s is inherited, what are the genes involved? Difficult question. Every cell in a person’s body has the same genes, but every cell is not the same. The differences between cells are not from different genes, but from differences in gene expression: every cell in the body is like
ß-catenin, Wnt and Dupuytren’s
Ultimately, Dupuytren’s has to do with cell signalling: normal cells are somehow instructed (“signalled”) to become abnormal, and adjacent cells interact with each other in a progression of abnormal changes. One of the many ways that cell signal each other is the Wnt signaling pathway, which involves a series of
Stretching may provoke Dupuytren’s
The relationships between mechanical forces and the biochemistry of Dupuytren’s are only recently being sorted out. Clinically, Dupuytren’s activity responds to changes in mechanical stresses: active nodules soften in response to reducing tension by adjacent fasciotomy; disease activity after fasciectomy may be provoked by overly aggressive stretching and splinting. Biochemically,
The Open Palm Technique for Dupuytren’s
The Open Palm Technique for Dupuytren’s contracture has advantages – lack of hematoma, lower incidence of sympathetic dystrophy. The classic McCash version of this procedure combines closure of zigzag finger incisions, leaving transverse palm wounds open. The Burkhalter version, developed by Dr. Mann, employs only transverse incisions in the palm
Chondroitin Sulfate, Dermatan Sulfate and Dupuytren’s
Dermatan sulfate is similar to the nutritional supplement chondroitin sulfate, and used to be called chondroitin sulfate. Dermatan sulfate is unusually abundant in fascia affected by Dupuytren’s. Is it the cause or is it the effect of the abnormal biology of Dupuytren’s? Maybe both, as discussed in this review: https://dupuytrens.org/DupPDFs/2007_Kozma.pdf
Open fasciotomy for Dupuytren’s
Patients with Dupuytren’s need two things, mechanical and biological. The former, a simple and safe way to straighten bent fingers, and the latter, a way to prevent disease progression and recurrence. This article reviews pros and cons of a simple mechanical treatment, open fasciotomy, for severe contractures in a group
Genetic determined biochemistry and Dupuyren’s
The genetic basis of Dupuytren’s is explained by the genetic basis of individual biochemistry and enzymatic variation. Sort of. This fascinating review shows how complicated this can be: https://dupuytrens.org/DupPDFs/2008_Zyluk.pdf
Verapamil, tamoxifen, carnitine – options?
One resource for potential medical treatment of Dupuytren’s is the literature on medicines which work for related conditions such as Peyronie’s. This review examines the rationale and results of propionyl-L-carnitine, acetyl-L-carnitine, verapamil and tamoxifen in treating Peyronie’s disease. Is there a role for these in Dupuytren’s? https://dupuytrens.org/DupPDFs/2002_Cavallini.pdf
Recent Dupuytren Publications
- Discussion: Frequency and Reporting of Complications after Dupuytren Contracture Interventions: A Systematic Review and Meta-Analysis
- The effect of preoperative interventions on postoperative outcomes following elective hand surgery: A systematic review
- Palmoplantar keratoderma, knuckle pads, and syndactyly associated with a new missense variant in the SLURP1 gene
- Post-traumatic Dupuytren's contracture in a paediatric patient: a case report and literature review
- Collagenase injection versus limited fasciectomy surgery to treat Dupuytren's contracture in adult patients in the UK: DISC, a non-inferiority RCT and economic evaluation
