Background: The palmar aponeurosis is extremely adherent
to the skin superficial to it. Many pretendinous coarse
fibers enter the dermis at an angle in the whole palm, not only
at the palmar creases. It is difficult to distinguish whether
Dupuytren's disease (DD) starts in the dermis or the palmar
aponeurosis since the skin adheres so closely to the palmar
fascia.
Objectives: In this work, we investigate the clinical and
histological origin of DD, as well as its impact on disease management.
Patients and Methods: A prospective clinical study was
conducted on 47 patients, 42 males and 5 females, who presented
with Dupuytren's contracture (29 cases were bilateral
and 18 were unilateral) between April 2012 and September
2020. We surgically removed all the diseased tissue and cords
together with 2-3 mm of the adherent overlying skin, and then
the excised tissue was submitted to histopathological examination.
Results: All our specimens showed chronic inflammatory
skin lesions with hyperkeratotic epidermal covering and dermal
infiltration with aggregates of chronic inflammatory cells,
mainly lymphocytes and plasma cells, as well as proliferated
vascular spaces and fibrous stroma. Clinical satisfaction was
excellent in 67 (88.2%) hands, good in six (7.8%) hands, fair
in three (4%) hands, and there were no poor results. We had
no recurrence in any of our cases after an average follow-up < br />period of 4.2 years.
Conclusions: DD is a chronic inflammatory disease that
affects both the palmar fascia and skin, as we have seen histologically
and surgically. The adhering skin and accompanying
cord must be removed for a considerable reduction in recurrence.
Whether it originates from fascia or skin, needs further
investigation.