Treatment of Dupuytren's Contracture at the Present Stage (Literature Review)

Abstract

Dupuytren disease is widespread among the population of different countries (3 %) and affects the working-age male population to a greater extent.

The progressive nature of the course of Dupuytren disease causes a persistent and significant decrease in the functional capabilities of the hands of patients and leads to a limitation of fine and high-precision activity on average in 67 % of patients, and in 3 % causes disability.

The problem of treating patients with Dupuytren's contracture remains relevant despite the achievements ofhand surgery. A large number of applied methods speaks of both the urgency of the problem and the possibility of a comprehensive approach to treating patients with this disease at different stages and with varying degrees of severity of contracture of the fingers. Many techniques for treating Dupuytren's contracture and their modifications are described. These are extensive surgical interventions, which involve the complete excision of the palmar aponeurosis, and selective open interventions, which involve the removal of only macro-modified areas - the bundle of the palmar aponeurosis through one large or several small accesses. With the development of minimally invasive techniques, needle-based aponeurotomy methods have spread, which do not imply the removal of pathologically altered tissues, but only relieve tension in the tissue by dissecting it and thereby increase movements in the joints of the fingers. With the development of pharmacology, methods for the enzymatic destruction of the bundle of pathologically altered palmar aponeurosis have appeared.

The evolution of approaches to the treatment of Dupuytren's contracture is visible in a gradual transitionfrom complete excision of the palmar aponeurosis to selective techniques, and from them to partial dissections and further to needle and enzymatic methods. However, despite the abundance of methods and good results in treating patients with this pathology, there remains a percentage of relapses, complications and adverse outcomes, the reduction of which is the purpose of developing a modern understanding of this pathology.