gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

Dupuytren disease: the superficial transverse palmar ligament and the septa of Legueu and Juvara: anatomic, biochemical and immunohistochemical study

Meeting Abstract

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  • presenting/speaker Isabella Fassola - Klinik für orthopädische und Unfallchirurgie, Charit, Berlin, Germany
  • Senat Krasnici - Klinik für orthopädische und Unfallchirurgie, Charit, Berlin, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO21-916

doi: 10.3205/17dkou752, urn:nbn:de:0183-17dkou7520

Published: October 23, 2017

© 2017 Fassola et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: The superficial transverse palmar ligament (STPL) and the septa of Legueu and Juvara (SLJ) are normal components of the palmar aponeurosis. Whereas the longitudinal pretendineous bands of the palmar aponeurosis are clearly involved in the development of the Dupuytren's disease, the involvement of the STPL and of the SLJ in the disease is still controversial. Fasciectomy with preservation of the STPL and of the SLJ is the reportedly has reduced risks of hematoma and thus results in rapid recovery. Nevertheless, this technique has been criticized because the recurrence rate of the disease could be attributed to the persistence of pathological tissue. In the recent years there has been increased interest in studying the histological, biochemical and immune-histochemical characteristic of the normal and the pathological palmar aponeurosis to increase understanding of the pathogenesis of the disease. However little is known about the intrinsic differences between the STPL and SLJ and the longitudinal pretendineous bands. Their role in the pathogenesis of the Dupuytren's disease is still unclear. Understanding the constituents of each component of the palmar aponeurosis will help the surgeon better understand the pathophysiology of DD and support the surgical decision of preserving vs resecting the STPL and the SLJ during fasciectomy for the treatment of Dupuytren's disease.

The aim of the study is to investigate the biochemical and immune-histochemical characteristics of the superficial transverse palmar ligament, the aponeurotic fascia and the septa of Legueu and Juvara from normal fascia.

Methods: Six fresh cadaveric healthy hands (24 digits) amputated at the proximal forearm were obtained within 24 hours of death and analyzed. The palmar skin and soft tissue of the palm and fingers were carefully removed from the palmar aponeurosis and digital sheath. The longitudinal pretendineous bands of the palmar aponeurosis, the superficial transverse palmar ligaments and the septa of Legueu and Juvara were harvested, marked for orientation and sent for analysis. For each component of the palmar aponeurosis (longitudinal pretendineous bands, STPL and SLJ) the following analysis were conducted: amount of total collagen, staining for expression of different collagen molecules, quantification of TGF-ß1 and NGF by ELISA. The differences between the different components were recorded.

Results and Conclusion: The results of biochemical and immunohistochemical studies on different components of the palmar aponeurosis are presented. The results help understanding the pathogenesis of Dupuytren disease and may also support the rationale for surgical preservation or excision of the superficial transverse palmar ligament during fasciectomy for the treatment of Dupuytren's disease.