Assessment of palmar subcutaneous tissue vascularization in patients with Dupuytren's contracture

Abstract

Aim: To investigate the structural and functional characteristics of palmar hypodermal tissue vascularization in Dupuytren's contracture patients of different age groups.

Methods: Eighty-seven Dupuytren's contracture patients underwent partial fasciectomy. Twenty-two of them were less than 55 years old (Y-group, n = 22); the others were 55 and older (O-group, n = 65). In surgically excised representative tissue samples, a histomorphometric analysis of the perforating arteries of the palmar aponeurosis and stereologic analysis of hypodermis vascularity were performed. The method of laser flowmetry estimated the microcirculation of the skin of the palm.

Results: Frequency of cases with rapid development of contracture (less than 5 years) was 13.6% in the Y-group and 40% in the O-group, P < 0.05. The external and luminal diameters of perforating arteries in palmar fascia were decreased more severely in Y. The thickness of intima increased three times compared with healthy control, and the intima/media relation also increased, especially in O. Increased numerical and volumetric micro-vessel densities in hypodermis, percentage of large vessels (more than 12 μm in diameter), and percentage of vessels with signs of periadventitial inflammatory infiltration were noted in Y. The percentage of vessels with adventitial fibrosis was greater in O than in Y. Base capillary flow in Y was increased compared to healthy control subjects and to O, and peak capillary flow was increased in comparison with control.

Conclusion: Compared to the O-group, Y-group patients exhibited more severe constrictive remodeling of palmar fascia perforating arteries supplying hypodermis but more expressed compensatory changes of its capillarization.

Keywords: Dupuytren’s contracture; Histo-morphometry; Hypodermis; Laser Doppler flowmetry; Palmar fascia.

Figure 1

Assessment of skin microcirculation in patient with Dupuytren’s contracture using laser Doppler flowmetry and local ischemic test.

Figure 2

Transverse paraffin sections of palmar fascia perforating arteries from Dupuytren’s contracture patients. A: Almost normal structure of perforating artery; B: Adventitial fibrosis, constriction of media and deformity of artery lumen; C: Artery with thick neointimal layer; D: The same artery with breakdown of internal elastic laminae evident due to specific elastin staining (dark brown); E: Extreme lumen narrowing due to neointimal thickening; F: Residual fragments of old internal elastic laminae newly formed elastic fibers in the neointimal layer. Staining: Hematoxylin-eosin (A, B, C, E); Weigert - van Gieson (D, E). Magnification 200 ×.

Figure 3

Fragments of hypodermis paraffin sections from Dupuytren’s contracture patients. A: Thick-walled capillaries in adipose tissue of hypodermis; B: Inflammatory infiltration of vascular pool; C: Multilayered round-cellular cuff outside the narrowed vessel; D: Perivascular and intramural infiltration with lymphocytes and macrophages; E: Pronounced perivascular fibrosis; F: Collagen deposits and perivascular clusters of fibroblasts. Staining: Hematoxylin-eosin. Magnification 200 ×.