Assessment of hemodynamics of the hand arteries and skin microcirculation in Dupuytren's contracture stages 3 to 4 of before and after surgical treatment with the use of Ilizarov transosseous fixation

Dolganova T.I., Shchudlo N.A., Shabalin D.A., Kostin V.V.

Abstract


Purpose
Hemodynamics of the hand arteries and microcirculation of the skin in patients with Dupuytren's contracture in grades 3-4 at the stages of treatment with the use of transosseous fixation was analyzed.
Materials and methods
Skin microcirculation using laser Doppler flowmetry as well as the microhemodynamics of the arcus palmaris superficialis and the digital arteries using pulse Doppler sonography were studied in 12 patients before surgery and following two to 11 months after the surgery of selective fasciectomy, arthrolysis and transosseous fixation. The state of the arteries of the palmar aponeurosis was verified histologically using light microscopy of paraffin sections of the surgical material.
Results
Before surgery, seven out of 12 patients had vasoconstriction of the digital arteries on the ulnar side of the hand and the palmar arch. Histologically, the arteries of the palmar aponeurosis were of small caliber (four or less layers of smooth muscle cells in the media) with signs of muscle hyperplasia and remodeling of the elastic membrane; larger arteries featured damage to the internal elastic membrane and neointimal thickening. Eight to 10 days after the intervention, there were no hemodynamic signs of vasoconstriction; volumetric systolic velocity was increased three times. At long-term follow-up after the surgery, the index of peak blood flow was increased 1.5 times (p less 0.05) relative to the values of the immediate postoperative period. Discussion In the postoperative period, the reactivity of the vessels of the precapillary flow was reduced and the spastic-stasis type of microcirculation prevailed. However, the potential of the microvascular bed was not impaired.
Conclusion
The method applied for treatment of Dupuytren's contracture provides correction of the deformity of the hand and elimination of vasoconstriction which is the most important trigger in the pathogenesis of fascial fibromatosis.

Keywords


Dupuytren's contracture, microhemodynamics, histology

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