On the treatment of Dupuytren's contraction of the fingers / by James Hardie.

  • James Hardie
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of Dupuytren's contraction of the fingers / by James Hardie. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Now, in order to succeed in straightening out the contracted fingers mere division of the fascial cords cannot, with this condition of &the skin, be sufficient. A certain advantage will no doubt be obtained, but the puckered and unyielding skin will immediately be put on the stretch, and unless means be taken to unfold this, such advantage will be very slight and very transitory. It might be supposed that, by passing the tenotome horizontally between the skin and fascia, this might be accomplished. But, knowing pretty well how much may be accomplished by subcutaneous operation, I am persuaded that it would be perfectly futile, for most people at least, to expect in this manner to effect such a thorough separation of the two structures, in even a very moderately pronounced case, as will permit of the fingers being fairly well brought down. In slight cases it may be possible, and if this method be reserved for these, good and well. I hold, therefore, that good results in the treatment of this deformity by either of the above methods cannot reasonably be hoped for, and that in moderately severe cases a little amelioration is the utmost that can be gained. The method of Goyrand, published in 1834,* three years after Dupuytren’s case, seems much better to fulfil the indications of a well-devised operation. Those indications are, accessibility to the contracted tissues, and healing of the wound with a minimum amount of inflammatory exudation. Perhaps in the days of Goyrand the latter indication was not well fulfilled; but now, as I hope to show, with recent improvements in dressing, there is no difficulty in obtaining complete primary union of the wound. This operation consists, broadly, in making a longitudinal incision over the tense digital prolongations of the fascia, separating the skin from them, and cutting across the isolated cords. The lips of the incision are then brought together, and the fingers fixed in the extended position. In February last a case (Case I.) came under my care in which the attachment of the skin to the fascia was so very intimate and extensive that I was forced to adopt some method of treatment with a special view to its liberation. I unwittingly followed in the foot- steps of Goyrand, and was so well satisfied with the result that I have performed the same operation in three other cases since six hands in all. The only difference between my own practice and that of Goyrand, so far as I understand, is that I believe I attach more importance to the complete liberation of the skin than he appears to have done. Before narrating these cases, I shall describe the opera- tion which the outcome of my experience leads me to recommend. * Memoires de I’Acadi'mie Royale de Mddecine, Tome III,
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