Published online Sep 18, 2018. doi: 10.5312/wjo.v9.i9.130
Peer-review started: March 29, 2018
First decision: May 9, 2018
Revised: May 14, 2018
Accepted: May 31, 2018
Article in press: May 31, 2018
Published online: September 18, 2018
To investigate the structural and functional characteristics of palmar hypodermal tissue vascularization in Dupuytren’s contracture patients of different age groups.
Eighty-seven Dupuytren’s contracture patients underwent partial fasciectomy. Twenty-two of them were less than 55 years old (Y-group, n = 22); the others were 55 and older (O-group, n = 65). In surgically excised representative tissue samples, a histomorphometric analysis of the perforating arteries of the palmar aponeurosis and stereologic analysis of hypodermis vascularity were performed. The method of laser flowmetry estimated the microcirculation of the skin of the palm.
Frequency of cases with rapid development of contracture (less than 5 years) was 13.6% in the Y-group and 40% in the O-group, P < 0.05. The external and luminal diameters of perforating arteries in palmar fascia were decreased more severely in Y. The thickness of intima increased three times compared with healthy control, and the intima/media relation also increased, especially in O. Increased numerical and volumetric micro-vessel densities in hypodermis, percentage of large vessels (more than 12 μm in diameter), and percentage of vessels with signs of periadventitial inflammatory infiltration were noted in Y. The percentage of vessels with adventitial fibrosis was greater in O than in Y. Base capillary flow in Y was increased compared to healthy control subjects and to O, and peak capillary flow was increased in comparison with control.
Compared to the O-group, Y-group patients exhibited more severe constrictive remodeling of palmar fascia perforating arteries supplying hypodermis but more expressed compensatory changes of its capillarization.
Core tip: This is a retrospective study comparing the incidence of quick development of Dupuytren’s contracture (less than 5 years) and peculiarities of palmar hypodermal tissue vascularization and microcirculation in two age groups of patients undergoing partial fasciectomy. The quantitative characteristics of palmar fascia perforating arteries remodeling, the hypodermal adipose tissue vascularization, and skin microcirculatory flow in patients with Dupuytren’s contracture depending on age were represented for the first time. In patients younger than 55 years, the incidence of rapidly progressive contracture was two, nine times less than that in the older group. Both age groups were characterized with constrictive arterial remodeling, especially the younger group, but quantitative signs of compensatory capillaro- and arteriologenesis were more prominent in the younger group.