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Surgery

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General Surgery

Question
91 out of 142
 

The treatment of choice of Dupuytren's contracture is



A Passive stretching

B Hydrocortisone infiltration

C Total fasciectomy

D Subcutaneous fasciectomy

Ans. D Subcutaneous fasciectomy (REF. SCHWARTZ SURGERY 8TH EDITION PG 1698 CHP 42.

a. Dupuytren's contracture , (also known as morbus Dupuytren, Dupuytren's disease orpalmar fibromatosis) is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended .

b. It is an inherited proliferative connective tissue disorder which involves the palmar fascia of the hand.

c. The ring finger and little finger are the fingers most commonly affected.

d. In patients with this condition, the palmar fascia thickens and shortens so that the tendons connected to the fingers cannot move freely.

e. The palmar fascia becomes hyperplastic and contracts.

f. Dupuytren’s disease often starts with nodules in the palm of the hand and it can extend to a cord in the finger.

g. Normally the palmar fascia exists of collagen type I, but if a patient has Dupuytren’s disease the collagen type I changes to collagen type III, which is a lot thicker than collagen type I.

h. The contracture sets in slowly and treatment is indicated when the so called table top test is positive.

i. The limited or selective fasciectomy is widely been seen as the golden standard treatment for Dupuytren’s disease During the treatment the patient is under regional or general anesthesia.

Cause

a. Symptoms of Dupuytren's contracture include painful bumps (nodules) under the skin that develop into tight bands of tissue, causing the fingers to curl.

b. The cause of Dupuytren's contracture is not known.

c. There are factors that put people at greater risk for developing Dupuytren's contracture.

i. It is most common in people of Northern European or Scandinavian ancestry.

ii. It often runs in families .

iii. It may be associated with drinking alcohol and smoking.

iv. It is associated with certain medical conditions, such as diabetes and seizures.

v. It increases in frequency with age.

General Surgery Flashcard List

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