CONTRACTURA DUPUYTREN PDF

El trastorno afecta una capa de tejido que se encuentra debajo de la piel de la palma de la mano. Los dedos afectados no se pueden estirar por completo, lo cual puede complicar las actividades diarias, como colocar las manos en los bolsillos, ponerse guantes o dar la mano. Generalmente, la enfermedad comienza como un engrosamiento de la piel en la palma de la mano. A medida que avanza, la piel de la palma puede parecer arrugada o con hoyuelos.

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In most cases the graft is taken from the antecubital fossa the crease of skin at the elbow joint or the inner side of the upper arm. The skin on the inner side of the upper arm is thin and has enough skin to supply a full-thickness graft. The donor site can be closed with a direct suture. For one week the hand is protected with a dressing. The hand and arm are elevated with a sling. The dressing is then removed and careful mobilization can be started, gradually increasing in intensity.

It is less invasive than the limited fasciectomy, because not all the diseased tissue is excised and the skin incisions are smaller. The skin is opened with small curved incisions over the diseased tissue. If necessary, incisions are made in the fingers. The cords are placed under maximum tension while they are cut.

A scalpel is used to separate the tissues. They wear an extension splint for two to three weeks, except during physical therapy. After the excision and a careful hemostasis , the cellulose implant is placed in a single layer in between the remaining parts of the cord. The splint is worn continuously during nighttime for eight weeks.

During the first weeks after surgery the splint may be worn during daytime. These treatments show promise. The cord is sectioned at as many levels as possible in the palm and fingers, depending on the location and extent of the disease, using a gauge needle mounted on a 10 ml syringe. After the treatment a small dressing is applied for 24 hours, after which people are able to use their hands normally.

No splints or physiotherapy are given. Minimal follow-up was 3 years. When a comparison was performed between people aged 55 years and older versus under 55 years, there was a statistically significant difference at both MP and PIP joints, with greater correction maintained in the older group. Gender differences were not statistically significant. Complications were rare except for skin tears, which occurred in 3. This study showed that NA is a safe procedure that can be performed in an outpatient setting.

The complication rate was low, but recurrences were frequent in younger people and for PIP contractures. The difference with the percutaneous needle fasciotomy is that the cord is cut at many places. The cord is also separated from the skin to make place for the lipograft that is taken from the abdomen or ipsilateral flank.

The fat graft results in supple skin. The digits are placed under maximal extension tension using a firm lead hand retractor. The surgeon makes multiple palmar puncture wounds with small nicks.

The tension on the cords is crucial, because tight constricting bands are most susceptible to be cut and torn by the small nicks, whereas the relatively loose neurovascular structures are spared. After the cord is completely cut and separated from the skin the lipograft is injected under the skin. A total of about 5 to 10 ml is injected per ray. Thereafter the person returns to normal activities and is advised to use a night splint for up to 20 weeks. In a MCP joint contracture the needle must be placed at the point of maximum bowstringing of the palpable cord.

The collagenase is distributed across three injection points. After 24 hours the person returns for passive digital extension to rupture the cord. Moderate pressure for 10—20 seconds ruptures the cord. Most doctors do not value those treatments. Laser treatment using red and infrared at low power was informally discussed in at an International Dupuytren Society forum, [61] as of which time little or no formal evaluation of the techniques had been completed.

Only anecdotal evidence supports other compounds such as vitamin E. Hand therapy is prescribed to optimize post-surgical function and to prevent joint stiffness. The splint is used to provide prolonged stretch to the healing tissues and prevent flexion contractures. Although splinting is a widely used post-operative intervention, evidence of its effectiveness is limited, [63] leading to variation in splinting approaches.

Most surgeons use clinical experience to decide whether to splint. Cited disadvantages include joint stiffness, prolonged pain, discomfort, [64] subsequently reduced function and edema. A third approach emphasizes early self-exercise and stretching. It was concluded that presence of diathesis can predict recurrence and extension. Recurrence lacks a consensus definition. Furthermore, different standards and measurements follow from the various definitions.

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Contractura de Dupuytren

Causas La causa se desconoce. Los factores de riesgo son consumo de alcohol, diabetes y tabaquismo. Normalmente no se presenta dolor. En casos infrecuentes, los tendones o las articulaciones se inflaman y duelen. En casos graves, estirarlos es imposible. Pocas veces se requieran otras pruebas.

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