Dupuytren’s contracture is a local manifestation of a systemic process, and although the palmar fascia is the usual focus, what happens in the hand is a regional process, affecting the skin and the fatty layer under the skin as well as the fascia: it appears to be something which brews between the skin and the fascia, not just in the fascia. This concept and its consequences were eloquently reviewed by the late, great John Hueston in “The role of the skin in Dupuytren’s disease” (full text: https://dupuytrens.orgDupPDFs/1985_Hueston_1125.pdf). His observations regarding the anatomy (“A nodule is never found on the dorsal aspect of a palmar aponeurosis…”), the biology (“…obsession with the collagenous structure of the palmar tissues is at present being replaced by the more logical study of the cellular origins…”), and the logic of dermofasciectomy and full thickness skin graft for aggressive or recurrent Dupuytren’s are even more relevant today than when the article was published 25 years ago.
