A new method of operating on Dupuytren's contraction of the palmar fascia : together with the successful use of neural infiltration in such operations / by W.W. Keen.

  • William Williams Keen
Date:
[1906]
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Licence: In copyright

Credit: A new method of operating on Dupuytren's contraction of the palmar fascia : together with the successful use of neural infiltration in such operations / 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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    Extracted from the American Journal of the Medical Sciences, January, 1906 \ -»v a | I tgni t F ^ ^ y* A NEW METHOD OP OPERATING ON DUPUYTREN’S CONTRAC- TION OF THE PALMAR FASCIA, TOGETHER WITH THE’ SUGCBfeSFITL USE OF NEURAL INFILTR VYlOJ? Ilf ‘Sfofl OPERATIONS.1 By W. W. Keen, M.D., PROFESSOR OF SURGERY, JEFFERSON MEDICAL COLLEGE, PHILADELPHIA. In American Medicine for October 31,1903, p. 704, appears a brief paper read before this body two years ago, illustrating the successful use of neural infiltration of the median and ulnar nerves during an operation for Dupuytren’s contraction of the fingers of the left hand. The patient was a woman then sixty-two years of age, whose general health was very poor and who also had a very trouble- some chronic bronchitis and a very distinct cardiac murmur, and was exceedingly nervous about her heart and lungs. Hence, I used neural infiltration instead of general anaesthesia. The operation that I did for the Dupuytren contraction on her left hand was the one I have ordinarily done—namely, incision in the line of the pronounced bands and the removal by dissection of the contracting bands in the palmar fascia. October 16, 1905, two years and a half after this operation, I saw her again. The following notes illustrate her condition and the new operation that I was obliged to devise. For some months past there have been appearing nodules and depressions in the skin of the right palm corresponding to a triangle with its apex at a point in the middle line of the hand just above a line drawn transversely to the web of the thumb, the base of the triangle being a line drawn between the margins of the forefinger and little fingers at the level of the knuckles (see illustration). There was evidently beginning contraction of the fascia and there would soon be contraction of all of the four fingers to a greater or lest extent. The nodules and pits were so diffused over the palm that is seemed to me impossible by incision in the axis where later the bands of contraction would develop satisfactorily to remove the contract- ing tissue. Moreover, the operation that I had already done upon the left hand, in which I had dissected out these bands, had been fol- lowed by a recurrence of the disease, so that the fingers of the left hand were contracted almost as badly as before the first operation. Accordingly I decided upon operation after a new plan. I first infiltrated the skin just above the wrist over the median and the