Basic Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2018; 9(9): 130-137
Published online Sep 18, 2018. doi: 10.5312/wjo.v9.i9.130
Assessment of palmar subcutaneous tissue vascularization in patients with Dupuytren’s contracture
Nathalia Shchudlo, Tatyana Varsegova, Tatyana Stupina, Tamara Dolganova, Michael Shchudlo, Nathalia Shihaleva, Vadim Kostin
Nathalia Shchudlo, Tamara Dolganova, Michael Shchudlo, Nathalia Shihaleva, Vadim Kostin, Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
Tatyana Varsegova, Tatyana Stupina, Laboratory of Morphology of Federal State Budget Institution, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan 640014, Russia
Author contributions: Shchudlo N, Varsegova T, Stupina T, Dolganova T, Shchudlo M, Shihaleva N and Kostin V substantially contributed to the conception and design of the study, acquisition, analysis, and interpretation of data; all authors drafted the article, made critical revisions related to the intellectual content of the manuscript, and approved the final version of the article to be published.
Supported by The RF Ministry of Health within Government-Mandated Program for FSBI Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics” (RISC “ RTO”) for Scientific Research in 2018-2020 Yr./Yrs. No. АААА-А18-118011190119-5 from 11/01/2018.
Institutional review board statement: The article was reviewed by RISC “RTO” Review Board and statement including: (1) The manuscript is not simultaneously being considered by other journals or already published elsewhere; (2) The manuscript has no redundant publication, plagiarism, or data fabrication or falsification; (3) Ethical clearance for this study was obtained from the RISC “RTO” Institutional ethics committee; and (4) Material contained within the manuscript is original, with all information from other sources appropriately referenced.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Nathalia Shchudlo, MD, Academic Research, DM, Head, Clinics and Experimental Laboratory for Reconstructive Microsurgery and Hand Surgery, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, M. Ulianova Street 6, Kurgan 640014, Russia.
Telephone: +7-89-225631752 Fax: +7-83-522454060
Received: March 28, 2018
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
Research background

Patients with Dupuytren’s contracture are numerous in hand clinics. In most cases, conservative treatment is not curable. Surgical excision of diseased tissue and correction of contracture are effective but the risks of recurrence and extension of pathological changes are high. Measures of successful influence on course of the disease are absent.

Research motivation

Multiple studies of Dupuytren’s disease deal with transformations of connective tissue, its molecular mechanisms, peculiarities of cells immuno-histochemical phenotypes, and gene expression. Though vascular remodeling mediates pathogenesis of various diseases, little is known about changes in palmar fascia and hypodermis vascularity in Dupuytren’s contracture patients - especially its quantitative characteristics.

Research objectives

We wanted to analyze histological morphometric parameters of palmar fascia arteries and microvascularity of palmar hypodermis of Dupuytren’s contracture patients and to assess the functional parameters of microcirculation of palmar skin tissues. The main purpose was to present peculiarities of structural and functional characteristics of palmar hypodermal tissue vascularization in different age groups and to determine whether these groups differ in the rate of progression of the hand deformity.

Research methods

We identified clinical characteristics of Dupuytren’s contracture patients (n = 87), morphometric characteristics of palmar fascia perforating arteries (n = 30), stereologic characteristics of hypodermis, parameters of microcirculatory flow, and post-occlusive hyperemia test (n = 52) in Dupuytren’s contracture patients in younger and older groups and healthy controls in different age groups. Methods were standard, but to the best of our knowledge, they had not been used for Dupuytren’s contracture research.

Research results

Cases with rapid progression of hand deformity (less than 5 years) were more common in older patients (55 and more years old). Signs of arterial constrictive remodeling were more prominent in the younger group. Adipocytes content, microvessel density, and per cent of microvessels with signs of inflammatory infiltration were bigger in the younger group. Vessels with adventitial fibrosis were seen more often in the older group. Base capillary flow in the younger group was bigger than the healthy control subjects and the older group; peak capillary flow was increased in comparison with control.

Research conclusions

Constrictive remodeling of palmar fascia arteries in studied groups of patients was associated with the development of fascial fibromatosis rather than cardiovascular disease. In patients younger than 55 years, old compensatory changes of the microcirculatory bed in palmar hypodermis contributed to more benign course of the disease.

Research perspectives

Further analysis of functional and structural characteristics of blood vessels in different age and comorbidity groups of Dupuytren’s contracture patients are necessary for development of effective vasogenic therapy, which may effectively influence disease progression and extending.