Scanning Electron Microscopy of Palmar Fascia in Dupuytren’s Disease of Advanced Stage

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Relevance. Dupuytren’s disease (palmar fascial fibromatosis) affects primarily palmar and digital fascia and results in progressive wrist deformity in many patients and often with bilateral involvement. Absence of corresponding data on the patients with severe wrist deformities along with their treatment issues is the ground for targeted research of pathomorphology of advanced disease stages.

Purpose of the study — to identify features of ultrastructure of fibromatosis nodules and bands in palmar aponeurosis of patients with Dupuytren’s disease of grade III-IV.

Materials and Methods. The authors analyzed medical histories and surgical material of 20 patients aging 42–77 years. Segments from medial portion of pretendinous cord of IV digit were cut for examination under scanning electron microscope (JSM-840, Jeol, Japan).

Results. Irrespective of disease history (from 1 to 20 years) fibrbous-fibrillar network and fine cylindrical collagen fibers prevailed in nodules of pretendinous cord which formed semicircular and circular end coils. Empty lacunae, functionally active fibroblasts and close cellular pairs were observed in nodules. Bands differed from nodules by lesser cellularity and less content of fine fibers, orientation of thick fibers mainly along one axis, straightening segments of undulated twisting and separate twisted and tightly interwoven fiber fragments.

Conclusion. In Dupuytren’s disease of grade III-IV nodules maintain the role of active contractile centers. Despite relatively small cellularity of pathologically altered tissues there is a potential for progressing, propagation and recurrence of fibromatosis.

About the authors

N. A. Shchudlo

Russian Ilizarov Scientific Center „Restorative Traumatology and Orthopedics“


Natalia A. Shchudlo — Dr. Sci. (Med.), head of Clinical and Experimental Laboratory of Reconstructive-Plastic Microsurgery and Hand Surgery


Russian Federation

T. A. Stupina

Russian Ilizarov Scientific Center „Restorative Traumatology and Orthopedics“

Author for correspondence.

Tatiana A. Stupina— Dr. Sci. (Biol.), senior researcher, Laboratory of Morphology


Russian Federation

M. M. Shchudlo

Russian Ilizarov Scientific Center „Restorative Traumatology and Orthopedics“


Mikhail M. Shchudlo — Dr. Sci. (Med.), senior researcher, Laboratory Clinical and Experimental Laboratory of Reconstructive-Plastic Microsurgery and Hand Surgery


Russian Federation


  1. Engstrand C., Krevers B., Nylander G., Kvist J. Hand function and quality of life before and after fasciectomy for Dupuytren contracture. J Hand Surg Am. 2014;(39)7:1333-1343. DOI: org/10.1016/j.jhsa.2014.04.029.
  2. Michou L., Lermusiaux J.L., Teyssedou J.P., Bardin T., Beaudreuil J., Petit-Teixeira E. Genetics of Dupuytren’s disease. Joint Bone Spine. 2012;79(1):7-12. doi: 10.1016/j.jbspin.2011.05.027.
  3. Becker K., Tinschert S., Lienert A., Bleuler P.E., Staub F., Meinel A. et al. The importance of genetic susceptibility in Dupuytren’s disease. Clin Genet. 2015;87(5):483-487. doi: 10.1111/cge.12410.
  4. Larsen S., Krogsgaard D.G., Aagaard Larsen L., Iachina M., Skytthe A., Frederiksen H. Genetic and environmental influences in Dupuytren’s disease: a study of 30,330 Danish twin pairs. J Hand Surg Eur Vol.2015;40(2):171-176. doi: 10.1177/1753193414535720.
  5. Dibenedetti D.B., Nguyen D., Zografos L., Ziemiecki R., Zhou X. Prevalence, incidence, and treatments of Dupuytren’s disease in the united States: results from a population-based study. Hand (NY). 2011;6(2):149-158. doi: 10.1007/s11552-010-9306-4.
  6. Palmer K.T., D’Angelo S., Syddall H., Griffin M.J., Cooper C., Coggon D. Dupuytren’s contracture and occupational exposure to hand-transmitted vibration. Occup Environ Med. 2014; 71(4):241-245. doi: 10.1136/oemed-2013-101981.
  7. Lanting R., Broekstra D.C., Werker P.M., van den Heuvel E.R. Asystematic review and meta-analysis on the prevalence of Dupuytren disease in the general population of Western countries. Plast Reconstr Surg. 2014;133(3):593-603. doi: 10.1097/01.prs.0000438455.37604.0f.
  8. Dibenedetti D.B., Nguyen D., Zografos L., Ziemiecki R., Zhou X. Prevalence, incidence, and treatments of Dupuytren’s disease in the united States: results from a population-based study et al. Epidemiological profile of Dupuytren’s disease in Taiwan (ethnic chinese): a nationwide populationbased study. BMC Musculoskelet Disord. 2015;16:20. doi: 10.1186/s12891-015-0476-7.
  9. Holzer L.A., De Parades V., Holzer G. Guillaume Dupuytren: his life and surgical contributions. Hand Surg Am. 2013;38(10):1994-1998. doi: 10.1016/j.jhsa.2013.07.012.
  10. Ball C., Izadi D., Verjee L.S., Chan J., Nanchahal J. Systematic review of non-surgical treatments for early dupuytren’s disease. BMC Musculoskelet Disord. 2016;17(1):345. doi: 10.1186/s12891-016-1200-y.
  11. Kníže J., Miletín J., Nejedlý A., Chorvát M., Novotná K., Tichá P., Fibír A., Sukop A., Knížetová A. Current treatment options of dupuytren´s disease. Acta Chir Plast. 2018;59(3-4):142-148.
  12. Leclère F.M., Kohl S., Varonier C., Unglaub F., Vögelin E. Range of motion, postoperative rehabilitation and patient satisfaction in McP and PIP joints affected by Dupuytren Tubiana stage 1-3: collagenase enzymatic fasciotomy or limited fasciectomy? aclinical study in 52 patients. Arch Orthop Trauma Surg. 2018;138(11):1623-1631. doi: 10.1007/s00402-018-3034-6.
  13. Brazzelli M., Cruickshank M., Tassie E., Mcnamee P., Robertson C., Elders A. et al. Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation. Health Technol Assess. 2015;19(90):1-202. doi: 10.3310/hta19900.
  14. Bainbridge C., Dahlin L.B., Szczypa P.P., Cappelleri J.C., Guérin D., Gerber R.A. Current trends in the surgical management of Dupuytren’s disease in europe: an analysis of patient charts. Eur Orthop Traumatol. 2012;3(1):31-41. doi: 10.1007/s12570-012-0092-z.
  15. Reilly R.M., Stern P.J., Goldfarb C.A. A retrospective review of the management of Dupuytren’s nodules. j Hand Surg. 2005;30(5):1014-1018. DOI: 10,1016/j.jhsa.2005.03.005.
  16. Толстик А.Н., Дейкало В.П. Технология реабилитации пациентов с выраженными сгибательными деформациями и рецидивами контрактур пальцев кисти при болезни Дюпюитрена. Новости хирургии. 2006;14(3):33-41.
  17. Luck J.V. Dupuytren’s contracture: a new concept of the pathogenesis correlated with surgical management. J Bone Joint Surg Am. 1959;41(4):635-664.
  18. Wilutzky B., Berndt A., Katenkamp D., Koshmehl H. Programmed cell death in nodular palmar fibromatosis (Morbus Dupuytren). Histol Histopathol. 1998;13(1):67-72. doi: 10.14670/HH-13.67.
  19. Lam W.L., Rawlins J.M., Karoo R.O., Naylor I., Sharpe D.T. Re-visiting luck’s classification: a histological analysis of Dupuytren’s disease. J Hand Surg Eur. 2010;35(4):312-317. doi: 10.1177/1753193410362848.
  20. Verjee L.S., Midwood K., Davidson D., Essex D., Sandison A., Nanchahal J. Myofibroblast distribution in Dupuytren’s cords: correlation with digital contracture. J Hand Surg Am. 2009;34(10):1785-1794. doi: 10.1016/j.jhsa.2009.08.005.
  21. Hunter J.A.A., Ogdon C. Dupuytren’s contracture IIscanning electron microscopic observations. British J Plastic Surg. 1975;28:19-25.
  22. Legge J.W., Finlay J.B., Mcfarlane R.M. A study of Dupuytren’s tissue with the scanning electron microscope. J Hand Surg Am. 1981;6(5):482-492.
  23. Józsa L., Salamon A., Réffy A., Renner A., Demel S., Donhöffer A., Pintér T., Thöring J. Fine structural alterations of the palmar aponeurosis in Dupuytren’s contracture. a combined scanning and transmission electronmicroscopic examination. Zentralbl Allg Pathol. 1988;134(1):15-25.
  24. Tubiana R. Dupuytren’s disease of the radial side of the hand. Hand Clin. 1999;15(1):149-159.
  25. Vanek P., Strömberg J., Fridén J., Aurell Y. Morphological patterns of the pretendinous cord in Dupuytren’s disease: a predictor of clinical outcome? J Plast Surg Hand Surg. 2018;52(4):240-244. doi: 10.1080/2000656x.2018.1470521.
  26. Millesi H. Dupuytren’s contracture. In: european Instructional lectures. Berlin, Heidelberg: Springer Berlin Heidelberg, 2009. рр. 137-152.
  27. Байтингер В.Ф. Клиническая анатомия ладонного апоневроза. Вопросы реконструктивной и пластической хирургии. 2012;1(40):22-33.
  28. Provenzano P.P., Vanderby R. Jr collagen fibril morphology and organization: Implications for force transmission in ligament and tendon. Matrix Biology. 2006;25: 71-84. doi: 10.1016/j.matbio.2005.09.005
  29. Chiu H.F., Mcfarlane R.M. Pathogenesis of Dupuytren’s contracture: a correlative clinical-pathological study. J Hand Surg Am. 1978;3(1):1-10.
  30. Rombouts J.J., Noel H., Legrain Y., Munting E. Prediction of recurrence in the treatment of Dupuytren’s disease: evaluation of a histologic classification. J Hand Surg Am. 1989;14(4):644-652.
  31. Musumeci M., Vadalà G., Russo F., Pelacchi F., Lanotte A., Denaro V. Dupuytren’s disease therapy: targeting the vicious cycle of myofibroblasts? Expert Opin Ther Targets. 2015;19(12):1677-1687. doi: 10.1517/14728222.2015.1068758.
  32. Dumitrescu-Ionescu D. A new therapeutic approach to dupuytren’s contracture / disease (DD). Adv Plast Reconstr Surg. 2017;1(5):129-136.



Abstract: 247


CrossRef: 1

  1. Stupina TA, Migalkin NS, Shchudlo NA, Shchudlo MM. Detection of Fungi in the Palmar Aponeurosis in Patients with Dupuytren’s Contracture by Scanning Electron Microscopy. Traumatology and Orthopedics of Russia. 2020;26(1):147. doi: 10.21823/2311-2905-2020-26-1-147-152


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