2. The latter condition, the true “Dupuytren’s contraction,” is not, strictly speaking, a contraction of the palmar fascia, but consists of a chronic inflammatory hyperplasia, commencing in the corium and subcutaneous connective tissue, involving secondarily the palmar fasciæ, and tending to the formation of dense bands of cicatricial tissue which replace the normal structure.
3. It does not appear to be especially connected with pressure or friction of the palm by tools or other objects employed in manual occupations, but is probably caused by infective organisms which gain admission through epidermic lesions, usually located over the prominent heads of the metacarpal bones.
4. It is almost essentially a disease of middle and advanced age, more common in men than in women, occurring in all classes, tending to progress slowly through a long course of years, and liable to recurrence after operation.
5. It is connected with a special susceptibility, inherited or acquired, which cannot yet be accounted for or expressed in any known terms; but neither gout, rheumatism, rheumatoid arthritis, nor any other of the ordinary constitutional ailments has been proved to have any causative relation to the disease.
6. Cicatricial deformities of the digits resulting from burns and other severe injuries are often of a very distressing character, and especially those which prevent opposition of the thumb to the fingers. When the joints are not destroyed, the utility of the member may generally be restored by well-devised plastic measures, the new material being either an epidermic graft, or a skin flap taken from a convenient portion of the surface; but it is useless to lay down laws in detail for the treatment of these conditions, as the variations in the extent and position of the loss of substance are so great that only the ingenuity of the operator can guide him in the application of the general principles of plastic surgery.
CONTRACTION OF THE FINGERS DUE TO DEVELOPMENTAL IRREGULARITIES IN THE BONY AND LIGAMENTOUS ELEMENTS OF THE ARTICULATIONS.
There are certain affections of the fingers which have hitherto attracted little notice, but are interesting on account of their relationship to deformities of much greater frequency in the lower extremity. These are conditions of abnormal flexion and of lateral deviation of the phalanges at the inter-phalangeal articulations, the first of which corresponds exactly to the well-known deformity of the foot called “hammer toe.”
Fig. 6.