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
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.
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.
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.
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.
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.
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.
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.