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Division of Orthopedic surgery, Duke University NC, Durham.
At a cellular level, the major phenomenon in Dupuytren's contracture is an increase in proliferating fibroblasts, rather than an alteration in the type of fibroblasts. The collagen and glycosaminoglycan changes observed in the tissues of Dupuytren's contracture are likely to be secondary to changes in fibroblast density. Oxygen free radicals released from narrowed microvessels and from the fibroblasts themselves may play a role in stimulating fibroblast proliferation. Messina's experiments with continuous distraction and the success of limited fasciotomy indicate a role for physical forces in the pathogenesis of Dupuytren's contracture. The mechanism whereby physical events stimulate biochemical changes are undetermined, but preliminary investigations suggest that electrical fields and ion channels may be important. The future of Dupuytren's contracture rests with the delineation of these chemical and physical processes and their application and rigorous testing in the clinical setting.
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