DUPINTREN'S CONTRACTION OF THE PALMAR FASCIA.
In very slight cases the deformity may be kept from extending and even a cure may be sometimes effected by constant passive nay counts and massage with the careful application of a well-padded metal splint worn every night so as to keep the fingers fully extended by the use of elastic tractors. In the majority of cases this treatment, however, is useless, hut before resorting to surgical operation the hypodermic injec tion of Fibrolvsin or Thiosinamin should be tried and repeated for at least 20 times, 2 c.c. of Fibrolysin being injected into the palm of the hand, though any other region as the buttock may be selected. Many cases are on record where this treatment has caused entire absorption of the patho logical fibrous tissue whose slow contraction produces the deformity. Massage, passive movements and splints should be used at the same time.
The operation of subcutaneous division of the fibrous bands by a number of separate punctures avoiding the transverse palmar crease gives immediate results and permits of the extension of the fingers, but relapses arc the frequent outcome of this method even when a splint is assiduously applied afterwards.
The favourite procedure is to make a V-shaped incision and openly dissect back a flap of skin, removing entirely all the hands of fibrous tissue with the prolonged processes of normal fascia which go to the sides of the phalanges; when the deformity is reduced the sutured wound assumes a Y-shape.
Kocher insists upon thorough extirpation of the thickened and shortened palmar fascia with its extensions, after simple longitudinal incision of tie skin of the palm. He holds that no operation can guarantee against relapse unless it include prophylactic excision of healthy parts of the fascia.
Hutchinson advises the shortening of the affected finger by excising the head of the proximal phalanx. 'Fiji; relieves the deformity by allowing the finger to straighten out without dragging on the contracted bands.
The writer would suggest that perhaps the best method of treatment will be found to be the old subcutaneous fasciotomy followed up by massage, extension and splints, combined with a prolonged course of fibrolysin injections to prevent relapse.