A. Berger A.Delbrück P.Brenner R. Hinzmann (Eds.) Dupuytren's Disease Pathobiochemistry and Clinical Management With 143 Figures and 45 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest Prof. Dr. med. Alfred Berger Dr. med. Peter Brenner Klinik für Plastische, Hand- und Wiederherstellungschirurgie Prof. Dr. med. Axel Delbrück Dr. rer. nat. Rolf Hinzmann Institut für Klinische Chemie 11 Krankenhaus Oststadt, Medizinische Hochschule Hannover Podbielskistraße 380,30659 Hannover, Germany ISBN-13: 978-3-540-57239-8 e-ISBN-13: 978-3-642-78517-7 DOI: 10.1007/978-3-642-78517-7 Library of Congress Cataloging-in-Publication Data Dupuytren's disease: pathobiochemistry and c1inical management/ A. Berger ... [et aLl, (eds.). p. cm. Includes index. 1. Dupuytren's contracture. L Berger, Alfred. [DNLM: 1. Dupuytren's Contracture-physiopathology. 2. Dupuytren's Contracture-therapy. WE 830 D9453 1994) RD778.5.D88 1994 617.5'75-dc20 DNLMIDLC 93-34322 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of trans lation, reprinting, reuse of illustrations, recitation, broadcasting, repro duction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1994 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific state ment, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Typesetting: Best-set Typesetter Ltd., Hong Kong 24/3130-5 4 3 2 1 0 - Printed on acid-free paper Preface Dupuytren's disease has been known to physicians for cen turies. Although much effort has been spent on clarifying its origin and pathogenesis, our knowledge of it is stilllimited. However, re cent growth in our knowledge of the pathobio chemistry of connective tissue diseases in general has opened up new research and clinical perspectives regarding Dupuy tren's contracture. To encourage work in this field, it is necessary for the individual groups concerned with problems of the patho genesis and therapy of the disease to discuss continuously the state of the art in Dupuytren's research and to exchange clinical experiences and results of biochemical research. Following the meetings in Vienna (1983) and London, Ontario (1985), the progress in this field over the last 6 years was presented at the Hannover Symposium on Patho biochemistry and Clinical Management of Dupuytren's Disease in 1991. In particular, the impact of biochemical findings on the diagnosis and therapy of Dupuytren's disease was diseussed. Therefore, this volume starts with the pre sentation of new morphologieal aspects of the pathogenesis of Dupuytren's disease (part I). In parts II to VI a com prehensive delineation of general eonneetive tissue patho biochemistry is followed by an extensive diseussion of metabolie aberrations and abnormities of the maero moleeular extracellular structure of the palmar fascia in Dupuytren's contracture. Finally, parts VII and VIII deal with the methods to detect these chrateristics and the pro gress in diagnosis and surgical treatment procedures. Let us add one comment to the term "Dupuytren's disease". Although this disease has frequently been referred to as "Dupuytren's contracture" in past, we agree with numerous others that disease is the more appropriate word, reftecting the fact that this condition involves more than a medical shortening. Preface V This report of the Hannover conference should aid those coBeagues and research groups who could not attend the meeting and enourage and challenge them to actively participate in further enlightenment of the problems we are aB faced with in our work on this disease. December 1993 The Editors VI Preface Contents Morphology ................................... 1 W. Mohr and D. Wessinghage Morphology of Dupuytren's Disease 3 G. Brandes, E. Reale, P. Brenner, and T. Körner Interactions Between Proteoglycans and Collagen Fibrils in the Palmar Fascia in Dupuytren's Disease. . . . . . . . . . . . . . . . . . . . . . . . . . 16 G.A.C. MurrelI, M.J.O. Francis, and c.R. Howlett Myofibroblasts Are Not Specific to Dupuytren's Disease. . . . . . . . . . . . . . . . . . . . . . . . . . 24 A. Meinel The Significance of Skin Anchoring Fibres in Palmar Fibrosis: Brief Comment ............... 34 Pathobiochemistry of Fibrillar Component 35 A.J. Bailey Collagen Changes in Dupuytren's Disease 37 E.J. Menzel, J. Neumüller, A. Rietseh, and H. Millesi Connective Tissue Autoantibodies in Dupuytren's Disease: Associations with HLA DR3 ... . ... ...... 49 G.A.c. MurreIl and M.J.O. Francis Collagen Production by Cultured Dupuytren's Fibroblasts . . . . . . . . . . . . . . 62 Contents VII Proteoglycans and Glycosaminoglycans ............ 71 E. Gurr, M. Borchert, W. Borchert, and A. Delbrück Proteoglycans in Biopsies of Dupuytren's Contracture . . . . . . . . . . . . . . . . . . . . . . 73 N. Gässler Glycosaminog1ycan Distribution Pattern in Dupuytren's Contracture Biopsies. . . . . . . . . . . . . . 85 N. Gässler, P. Brenner, A. Berger, and A. Delbrück Biochemical Parameters for the Diagnosis of Dupuytren's Disease. . . . . . . . . . . . . . . . . . . . . . . . . . 94 Pathobiochemistry of Cells in Dupuytren's Contracture . . . . . . . . . . . . . . . . . . . . . . 99 J. Neumüller Investigations of Cell Cultures Derived from Patients Suffering from Dupuytren's Contracture . . . . . . . . . . . 101 A. Delbrück and H. Schräder Fibroblast Gel Culture: A Model for Biochemical Investigations of Dupuytren's Contracture 111 C. Sachse and P. Brenner Reactivity of Cells in Nodules of Dupuytren's Contracture with Monoclonal Antibodies Recognizing Leukocyte Antigens and von Willebrand's Factor . . . . . . . . . . . . . . . . . . . . . . . . . 117 D.T. Shum, G. Pringle, B. Hasegawa, J.S. Botz, and R.M. McFariane Demonstration of Myofibroblasts Using a Novel Murine Monoclonal Antibody, 3C2GI0.7 Raised from Proliferating Cells in Dupuytren's Disease . . . . . 127 I.L. Naylor, D.J. Coleman, R.A. Coleman, S.E. Cross, and I.T.H. Foo Reactivity of Nodular Cells in Vitro: A Guide to the Pharmacological Treatment of Dupuytren's Contracture . . . . . . . . . . . . . . . . . . . . . . 139 VIII Contents Extracellular Matrix Components and Macromolecular Interactions . . . . . . . . . . . . . . . . . . . . . 151 A.M. Gressner Stromal-Epithelial Cell Interactions in the Mechanisms of Hepatocyte Injury, Liver Cell Regeneration and Fibrogenesis . . . . . . . . . . 153 J.E. Scott Proteoglycan - Collagen Fibril Interactions in Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 H. Millesi, R. Reihsner, J. Menzel, G. Hamilton, and R. Mallinger Changes in the Biomechanical Properties of Diseased Tissue as Pathogenetic Factors in Dupuytren's Contracture . . . . . . . . . . . . . . . . . . . . . . 178 Fibromatoses .................................. 191 W. Mohr and D. Wessinghage Localization and Morphology of Different Fibromatoses ....................... 193 H. Notbohm, S. Mosler, and J. Hoch Thermal Stability and Fibrillogenesis of Collagen trom Tissue of Patients with Dupuytren's Disease . . . 202 S. Shoshan, I. Babayof, I. Peleg, F. Grinnell, N. Ron, S. Funk, and E.H. Sage Macrophage Activity, Fibronectin, and SP ARC Protein in Experimentally induced Granuloma 213 G. Gabbiani Modulation of Fibroblastic Cytoskeletal Features During Dupuytren's Disease . . . . . . . . . . . . . . . . . . . . . 222 G.A.C. MurreIl and M.J.O.Francis Oxygen Free Radicals and Dupuytren's Disease 227 Clinical Findings and Epidemiology of Dupuytren's Disease .... . . . . . . . . . . . . . . . . . . . . . . 235 P. Mailänder, P. Brenner, and A. Berger Clinical Findings in Dupuytren's Disease. . . . . . . . . . . 237 Contents IX P. Brenner, P. Mailänder, and A. Berger Epidemiology of Dupuytren's Disease . . . . . . . . . . . . . 244 Clinical Management of Dupuytren's Disease 255 J. Geldmacher Limited Fasciectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 P.Burge Fasciotomy and the Open Palm Technique . . . . . . . . . 264 J. Varian Skin Grafting in the Management of Dupuytren's Disease. . . . . . . . . . . . . . . . . . . . . . . . . . 268 C. Leclercq and R. Tubiana Recurrence in Dupuytren's Disease . . . . . . . . . . . . . . . 272 E. Euler, K. Wilhelm, and T. Kreusser Refinements of Plastic Surgery in Relapsing Dupuytren's Disease: Incisions, Flaps, Treatment of Perfusion Disorders, Physiotherapy, and Splinting 275 J. T. Hueston The Complications and Unsatisfactory Results of Treatment for Dupuytren's Disease . . . . . . . . . . . . . 285 A. Messina The Continuous Elongation Technique in Dupuytren's Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 291 Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 X Contents List of Contributors Babyof, 1., M.D. Connective Tissue Research Laboratory Hebrew University of Jerusalem P.O. Box 1172 Jerusalem, Israel Bailey, A.J., M.D. Muscle and Collagen Research Group Department of Veterinary Medicine Langford, Bristol BS18 7DY, Great Britain Berger, A., Prof. Dr. Klinik für Plastische, Hand-und Wiederherstellungschirurgie Krankenhaus Oststadt, Medizinische Hochschule Hannover Podielskistraße 380 30659 Hannover, Germany Borchert, M., Dr. Um Unter Dorf 30 38527 Meine, Germany Borchert, W., Dr. Medizinische Klinik I Städtisches Klinikum Braunschweig Salzdahlumer Straße 90 38126 Braunschweig, Germany Botz, J.S., M.D. Department of Pathology, Victoria Hospital University of Western Ontario 375 South Street London, Ontario N6A 4G5, Canada List of Contributors XI