Dupuytren contracture

Description

Dupuytren contracture: A gradual thickening and tightening of the fascia (fibrous tissues layer) under the skin of the palm and fingers in the hand.

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History

1822 – Sir Astley Cooper (1768-1841) reported digital contractures, and deemed them ‘incurable by operation‘

1831 – Dupuytren first to realise that the basic ‘lesion‘ for contracture lay in the palmar fascia rather than the skin or tendons. He operated on the contracture of a French wine merchant (1811) with success, taking a swipe at AP Copper at the same time

1833 – Jean-Gaspard-Blaise Goyrand (1793-1866) presented at l’Academie Royale de Médecine, claiming Dupuytren was in error on three points:

• Dissections showed bands flexing fingers and the thumb, beyond the normally accepted limits of the palmar aponeurosis
• A longitudinal incision allowed better healing and even some fascial excision (possibly the first fasciectomy)
• The condition was more hereditary than occupational in origin

1833 – Alfred Velpeau (1795-1867) contributed to the debate over the anatomical origin of permanent finger contracture. Velpeau reported a patient operated on at La Pitié in 1833 in whom the cord appeared to represent fibrous transformation of the subcutaneous layer.

1835 – Goyrand demonstrated that excision of a transverse segment of palmar aponeurosis and direct suture of this defect will produce flexion only at the MP and not at the IP joints. Goyrand proposed that the ‘predigital bands‘ which flexed the fingers, were formed from the ‘fibro-cellular subcutaneous tissue‘ of the fingers.

1835 – In the letter Sur la rétraction des doigts, Velpeau responded to Goyrand’s work and claimed priority for the fundamental pathological idea. He argued that the palmar aponeurosis could not alone explain the deformity because it terminated near the bases and sides of the fingers, whereas the pathological cord lay centrally and could extend as far as the distal phalanx.

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Associated Persons

• Sir Astley Cooper (1768-1841)
• Baron Guillaume Dupuytren (1777-1835)
• Jean-Gaspard-Blaise Goyrand (1793-1866)
• Alfred-Armand-Louis-Marie Velpeau (1795-1867)

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Alternative names

• Dupuytren’s disease
• Palmar fibromatosis

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Controversies

Sir Astley Cooper (1768-1841) had previously reported digital contractures, but deemed them “incurable by operation“

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References

Historical references

• Dupuytren G. De la rétraction des doigts par suite d’une rétraction de l’aponévrose palmaire. Paris, 1831; 2s; 5: 352-365.
• Dupuytren G. Permanent retraction of the fingers, produced by affection of the palmar fascia. Lancet, London, 1833-1834; 2: 222-225. English translation and reprint in Medical Classics, 1939; 4: 142-150
• Goyrand G. Nouvelles recherches sur la rétraction permanente des doigts. Mémoires de l’Académie royale de médecine, 1833, 3: 489-496. [Critique: Sanson J, Breschet G. 496-500] [Discussion following critique reported in Gazette médicale de Paris, 1834;2s(2):219 with comments by Barthélemey, Cloquet, Dupuy, Lisfranc, Martin-Solon and Velpeau…]
• Goyrand G. De la rétraction permanente des doigts. Gazette médicale de Paris. 1835; 2s(3): 481-486.
• Velpeau AALM. Sur la rétraction des doigts. Gazette médicale de Paris. 1835; 2s(3): 511.

Review references

• Peltier LF. Guillaume Dupuytren and Dupuytren’s fracture. Surgery. 1958;43(5):868-74.
• Elliot D. The early history of contracture of the palmar fascia. Part 1: The origin of the disease: the curse of the MacCrimmons: the hand of benediction: Cline’s contracture. J Hand Surg Br. 1988; 13(3): 246-253.
• Elliot D. The early history of contracture of the palmar fascia. Part 2: The revolution in Paris: Guillaume Dupuytren: Dupuytren’s disease. J Hand Surg Br. 1988; 13(4): 371-378
• Elliot D. The early history of contracture of the palmar fascia. Part 3: The controversy in Paris and the spread of surgical treatment of the disease throughout Europe. J Hand Surg Br. 1989; 14(1): 25-31.
• Gudmundsson KG, Arngrímsson R, Sigfússon N, Björnsson A, Jónsson T. Epidemiology of Dupuytren’s disease: clinical, serological, and social assessment. The Reykjavik Study. J Clin Epidemiol. 2000; 53(3): 291-296.
• Gudmundsson KG, Jónsson T, Arngrímsson R. Guillaume Dupuytren and finger contractures. Lancet. 2003; 362(9378): 165-168
• Gilgenkrantz S. Le baron Guillaume Dupuytren [The Baron Guillaume Dupuytren]. Med Sci (Paris). 2006; 22(8-9): 771-772. [PDF]
• Battaloglu E, Deshmukh RG. Dupuytren’s contracture: Current understanding of the condition and its management. Hard Tissue 2014;3(1):3