Pathogenesis of neuropathy in Dupuytren's contracture

Abstract

Objective To review pathomorphological characteristics of the nerves of the palmar aponeurosis in Dupuytren’s contracture and develop a hypothesis of injury mechanisms. Material and methods The study included retrospective analysis of medical charts and surgical records of 123 patients with Dupuytren’s disease grades 2-4 who underwent partial aponeurectomy, light microscopic micrography of histological preparations of nerve trunks ofpalmar aponeurosis stained with hematoxylin and eosin. Results Three major types of nerve injury to palm aponeurosis were identified in Dupuytren’s disease including (1) active and residual perineuritis (41.6 %), (2) necrosis of endoneurial blood vessels and endoneurium (22%), and (3) fibromatosis of nerve sheath (37.4%). Higher rate of bilateral fascial fibromatosis and right-side involvement in unilateral fibromatosis (p less 0.05) was observed in Group 2 as compared to Group 3. The mean time interval of contracture formation was shorter in Group 3 by 21/2 years as compared to Groups 1 and 2 (p less 0.05). Discussion Perineurial lymphocyte and histiocyte infiltration was shown to be an additional criterion of fascial fibromatosis. Necrosis of endoneurial blood vessels was easily suspected in combination of bilateral fibromatosis (strong evidence for familial predisposition) and chronic hand injury of manual handling. Fibromatosis of nerve sheath indicated to aggressive course of the disease. Conclusion Pathomorphological characteristics of neuropathy in Dupuytren’s disease allowed assessment of fibromatosis and prognosis of the course of the disease in an individual patient to administer postoperative immunocorrective and neurally mediated therapy for optimization of wound healing and recurrence prevention.