Evaluation of the Outcome of Combining Skin Excision with Limited Fasciectomy in the Treatment of Dupuytren’s Disease and its Histopathological Assessment

Background: The palmar aponeurosis is extremely adherentto the skin superficial to it. Many pretendinous coarsefibers enter the dermis at an angle in the whole palm, not onlyat the palmar creases. It is difficult to distinguish whetherDupuytren’s disease (DD) starts in the dermis or the palmaraponeurosis since the skin adheres so closely to the palmarfascia.Objectives: In this work, we investigate the clinical andhistological origin of DD, as well as its impact on disease management.Patients and Methods: A prospective clinical study wasconducted on 47 patients, 42 males and 5 females, who presentedwith Dupuytren’s contracture (29 cases were bilateraland 18 were unilateral) between April 2012 and September2020. We surgically removed all the diseased tissue and cordstogether with 2-3 mm of the adherent overlying skin, and thenthe excised tissue was submitted to histopathological examination.Results: All our specimens showed chronic inflammatoryskin lesions with hyperkeratotic epidermal covering and dermalinfiltration with aggregates of chronic inflammatory cells,mainly lymphocytes and plasma cells, as well as proliferatedvascular spaces and fibrous stroma. Clinical satisfaction wasexcellent in 67 (88.2%) hands, good in six (7.8%) hands, fairin three (4%) hands, and there were no poor results. We hadno recurrence in any of our cases after an average follow-up < br />period of 4.2 years.Conclusions: DD is a chronic inflammatory disease thataffects both the palmar fascia and skin, as we have seen histologicallyand surgically. The adhering skin and accompanyingcord must be removed for a considerable reduction in recurrence.Whether it originates from fascia or skin, needs furtherinvestigation.