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Surgery

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The treatment of choice of Dupuytren's contracture is (AIMS Nov 2009)



A Passive stretching
B Hydrocortisone infiltration

C Total fasciectomy
D Subcutaneous fasciectomy

Ans. D subcutaneous fasciectomy

Dupuytren's Contracture

It is a contracture of palmar aponeurosis extending into the digits

a. . Age - usually more than 50 year

b. .Sex - more common in males (2: 1 to l0: 1)

Etiology

a. Inherited as autosomal dominant condition

b. It is associated with age, smoking, pulmonary tuberculosis, epilepsy, AIDS, alcoholic, cirrhosis, diabetes.

Note-There is no proven relation of trauma, occupation, handedness or repetitive use in work or sports.

Pathology

a. Myofibroblast in the palmar fascia proliferate and it contract

b. Overlying skin then puckered

c. It mainly involves the longitudinally oriented fibers of palmar aponeurosis

d. Disease begin in ring and small finger (index finger in least involveD.

e. Flexion contracture at metacarpophalangeal and proximal interphalangeal joint occur

f. The skin over the back of the proximal interphalangeal joint may thicken causing Garrod’s Knuckle pad.

g. Few patients may have thickening in the penis (Peyronie’s diseasE. or on the sole of foot

h. (Ledderhose’s diseasE.

Treatment

a. Early cases- stretching exercise, Vitamin E (high dosE.

b. Surgery is indicated if deterioration is rapid

- Fasciectomy - Z-plasty

Note- Surgery is not curative and recurrence is very common.

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