Evaluation of the outcome of combining skin excision with limited fasciectomy in the treatment of Dupuytren's Disease and its histopathological assessment

BackgroundThe 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 palmar creases. It's difficult to distinguish whether Dupuytren's disease (DD) starts in the skin's dermis or the palmar aponeurosis since the skin adheres so closely to the palmar fascia.In this work, we have investigated the clinical and histological origin of DD, as well as its impact on the disease's management. 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 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 showing 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 period of 4.2 years.Conclusions DD is a chronic inflammatory disease that affects both the palmar fascia and skin, as we've 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.