Dupuytren's finger contraction : operation by removal of the contracting band by open wound, immediate cure without reaction or pain / by W.W. Keen.

  • William Williams Keen
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Dupuytren's finger contraction : operation by removal of the contracting band by open wound, immediate cure without reaction or pain / by W.W. Keen. 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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    DUPUYTREN'S FINGER CONTRACTION. OPERATION^ BY REMOVAL OF THE CONTRACTING BAND \ Z. BY OPEN WOUND. IMMEDIATE CURE WITHOUT REACTION OR PAIN. By W. W. keen, M.D., PROFESSOR OF SURGERY IN THE JEFFERSON MEDICAL COLLEGE, Wti. j _^ [Read September 11, 1889.] The patient was a medical friend, aged thirty-eight. His father had con- traction of one great toe. Eepeatedly in earlier life the patient lias had more or less rheumatism in his shoulders for a few days at a time. At eleven years of age he cut the peroneal muscles of the left leg with an axe, and, soon after this, trouble with his left leg set in. The division of the peroneus longus made his ankle unstable, and his foot is apt to be inverted in consequence of the loss of support on its outer side. There is also a markedly exaggerated arch of the foot with contraction of the plantar fascia. Whether this is the direct result of the muscular injury is somewhat doubtful. He has also suf- fered during the last two years considerably with eczema of both hands and of the body. At the age of twenty-eight he noticed a depression in the palm of the left hand in the axis of the middle finger. Contraction, with thickening of the fascia and the formation of a distinct cord, began from one to three years later. June 1, 1889. The first joint of the left middle finger is flexed one-third, the first phalanx alone being involved. The palmar cord is very marked ; it extends just to the base of the phalanx. At its digital extremity two lateral bands extending to the fore- and ring-fingers have recently begun to form, threatening contraction of these two fingers. The hand having been prepared autiseptically, I made an incision two and one-half inches long, half an inch over the first phalanx of the finger and two inches in the palm. The skin was reflected on each side, exposing the band, and at its lower end the two lateral slips. The flaps of skin though thin bled very freely, which I was glad to see, as it insured them against any possible gangrene. The cord was entirely excised, care being taken to remove very thoroughly also the two lateral slips to the fore- and ring-fingers, as well as the main cord. The flexor tendons were seen in the common sheath beneath the fascia, but no injury was done to either sheath or tendon. A few horsehairs were used for drainage. An ordinary dry bichloride dre.ssing was applied and the hand was bandaged. No splint was used, nor was the subsequent