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Plastic Surgery( Grabb)Ali jasim > Dupuytren Disease > Flashcards

Dupuytren Disease Flashcards

1
Q

Moreaggressive (invasive) treatment options may reduce rate
ofrecurrence, but may be accompanied by increased risk

A

T

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2
Q

there is no cure for
this chronic disorder

A

T

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3
Q

most prevalent in persons of Caucasian descent.

A

T

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4
Q

DD has been described in nearly every ethnicity

A

T

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5
Q

F>M

A

F Men are affected
more often than women,

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6
Q

most common in the sixth decade of life

A

T

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7
Q

When the incidence of DD became equal between M and F

A

beyond the eighth decade, the incidence of DD in men and women
becomes nearly identical

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8
Q

Reports of DD in infants and children
are very rare.

A

T

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9
Q

There are no genetic factor in development of DD

A

F DD has both a genetic and an
environmental component

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10
Q

genetic factors must be playing a major
role. The authors concluded that the heritability of DD was approximately 80%

A

T

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11
Q

What gene responsible for DD?

A

no single gene has been implicated

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12
Q

Etiology must be multifactorial

A

T

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13
Q

DD CAN EASILY be DIAGNOSED BY genetic test

A

F there is currently no genetic test
for DD

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14
Q

manual labor cigarette and alcohol consumption have been linked with
increased prevalence of DD

A

T

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15
Q

liver disease increased risk of DD

A

F Despite the increased prevalence of DD in alcoholics, for example, patients with liver disease due to other causes do not have an increased risk of DD

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16
Q

increased risk of DD in patients with seizure disorders

A

T

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17
Q

Increase the incidence of DD with antiseizure medication wich medics?

A

the common antiseizure drug, phenobarbital

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18
Q

another risk factor for DD

A

diabetes mellitus, human
immunodeficiency virus, hypercholesterolemia, hypertriglyceridemia, frozen shoulder, and rock climbing

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19
Q

negative risk factor for the development of DD

A

is the
presence of rheumatoid arthritis

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20
Q

the common pathway
for development of DD is the transformation of fibroblasts to myofibroblasts

A

T

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21
Q

DD stages

A

■ Proliferative stage: nodules form as fibroblasts proliferate
■ lnvolutional stage: contractures form, collagen is produced, cellularity reduced
■ Residual stage: nodules regress, hypocellular cords remain

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22
Q

Why increased ratio of type Ill to type I collagen

A

reaction to the increased fibroblast density in this disorder

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23
Q

pretendinous cords cause PIP contractures

A

F pretendinous cords cause metacarpophalangeal joint
(MCP) contractures

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24
Q

whereas central and spiral cords cause proximal interphalangeal joint (PIP) contractures

A

T

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25
Q

Wich cord cause contracture in the web space

A

Natatory cords can lead to
webspace contractures; this may be referred to as a commissural cord
at the thumb-index web.

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26
Q

Cause of contracture in the DIP

A

Deep retrovascular cords and extensions
of lateral cords have been implicated in the distal interphalangeal joint
(DIP) contractures

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27
Q

the DIP joint sometimes becomes contracted in hyperextension, as these cords are often dorsal to the axis
of rotation of that joint.

A

T

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28
Q

Spiral cords are particularly notorious in that they displace the
neurovascular bundle as they contract

A

T

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29
Q

as
the spiral cord contracts, it displaces the neurovascular bundle proximally, centrally, and superficially related to its native position

A

T

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30
Q

digital nerve appears to be spiraling around the cord, leading some authors to prefer the term spiral nerve
rather than spiral cord

A

T

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31
Q

What is the isolated digital cord?

A

This unique cord originates
from the fascia or tendon of the abductor digiti quinti muscle, and it
can cause PIP and sometimes DIP contractures of the small finger.

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32
Q

factors that might predict a greater risk of early recurrence

A

■ Bilateral palmar disease
■ Family history of DD
■ Ectopic disease
■ Ethnicity

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33
Q

Ectopic disease ?

A

Ledderhose disease (plantar fibromatosis), Garrod pads (knuckle pads over the
dorsum of the PIPjoints),
and Peyronie disease (fibrotic disease causing curvature of the penis).

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34
Q

male patients
and younger patients also tended to have increased risk ofrecurrence
and/or extension

A

T

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35
Q

the risk associated
with Garrod pads was higher than that associated with other forms of
ectopic disease

A

T

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36
Q

modern definition ofDupuytren
diathesis

A

■ Male gender
■ Bilateral disease
■ Family history
■ Garrod pads
■ Age of onset less than 50

37
Q

Staging systems
have been developed based on degrees of contracture is useful in planing of the surgfery

A

F these are rarely used in practice, as they are not really
helpful in determining a course of treatment

38
Q

tabletop test is often
used as a simple tool to help patients monitor their disease:

A

T

39
Q

isolated MCP
contractures are easily corrected by many methods, why?

A

because that the collateral ligaments do not become pathologically shortened
when these joints are fixed in flexion for significant periods of time

40
Q

PIP joints positioned in flexion for long periods of time
develop intrinsic joint contractures, which limit the overall success
rates of treatment

A

T

41
Q

mild MCP contractures (less
than 30°) can be observed safely, but progressive PIP contractures
should have earlier intervention to obtain the best outcome.

A

T

42
Q

Hyperbaric oxygen used in DD treatment

A

T

43
Q

Seriod used topically only

A

■ Intralesional steroid injection
■ Topical steroids
■ Oral steroids
■ Intramuscular steroids

44
Q

External beam radiation can be used in treatment of DD

A

T

45
Q

steroid injection and radiotherapy appeared to offer some benefit

A

T

46
Q

Needle aponeurotomy asdvantages?

A

as the advantage of a rapid recovery, minimal
discomfort, high patient satisfaction, and lower cost

47
Q

a steep learning curve and most studies
have shown higher and faster rates of recurrence compared to other treatments. There is also a small risk of tendon and/or digital nerve injury.

A

T

48
Q

Needle aponeurotomy indication

A

Needle aponeurotomy can be considered for any symptomatic MCP
or PIP joint contracture with a palpable cord

49
Q

not a good choice
for patients that have experienced rapid recurrence following treatment
or in patients with severe scarring or skin shortening

A

t

50
Q

The effectiveness
of needle aponeurotomy is increased by corticosteroid (triamcinolone)
injection

A

T

51
Q

Collagenase injection, requires two separate visits

A

T one for injection
of CCH, and one for manipulation of the digit into extension

52
Q

two cords in the same hand simultaneously can injected at the same time

A

T

53
Q

Collagenase injection use in the treatment of Peyronie disease

A

T

54
Q

CCH injection frequently causes localized bruising and pain, and
occasional lymphadenopathy and manipulation-related skin tears

A

T

55
Q

IN fasciectomy removes just the diseased fascia (limited fasciectomy) or remove both diseased
and nondiseased fascia (radical fasciectomy)

A

T

56
Q

In modern practice,
radical fasciectomy is uncommonly performed due to its increased
morbidity

A

T

57
Q

Dissection of the diseased cord proceeds from proximal to distal in most cases,
starting in the proximal palm

A

T

58
Q

the deeper, transverse
fascia! fibers may become disease

A

F the longitudinal fascia! fibers may become diseased, but the deeper, transverse fascia! fibers remain disease-free.

59
Q

Once dissection
reaches the distal third of the palm, the transverse fascia

A

T

60
Q

In case of joint contractures persist in spite of the complete release of the cord what you can do?

A

In practice, it may be best to proceed with
PIP joint capsulotomy and/or ligamentous release in select cases,

61
Q

Ifcomplete skin closure is not possible, skin grafting can be performed, or
wounds can be left open to heal by secondary intention.

A

T

62
Q

McCash open palm technique

A

advocated transverse incisions in the palm and digits to perform the
required fasciectomy, followed by weekly dressings with nonadherent
gauze until healed

63
Q

STSG can be used in case of the wound canot closed

A

F small full-thickness skin
grafts when skin closure is not possible without tension

64
Q

that full-thickness skin graftscouldact as afirebreak

A

T

65
Q

wide excision ofdiseased fascia and involved skin (dermofasciectomy), especially in recurrent cases can be employed

A

T

66
Q

Option of treatment of recurrent cases

A

Recurrent cases pip capsulotomy ligaments release and dermofasictomy and steroid injection

67
Q

patients closed with Z-plasty
to those closed using small full-thickness skin grafts at the intended
Z-plasty site. No difference in recurrence was noted between the two
groups

A

T

68
Q

Skin can’t involve directly with DD

A

T Because the fibers ofthe palmar fascia attach to the skin in multiple locations, it is not surprising that the skin can become directly involved with DD

69
Q

Soft tissue distraction has been used to treat Dupuytren contractures, relying on slow steady stretch to help overcome problems

A

T Digit Widget*
gradual tissue lengthening can be accomplished slowly over a period
of weeks or months, making subsequent surgery easier and more
successful

70
Q

Benefit of preliminary distraction

A

T skin deficiency Vascular compromise due to stretched arteries, and intrinsic PIP joint contractures can be overcome with the preliminary distraction
better degree of contracture correction

71
Q

Ligament release is better than preliminary, destruction

A

When compared to fasciectomy and checkrein ligament release, preliminary, destruction
was shown to provide a better degree of contracture correction

72
Q

Percutaneous aponeurotomy and lipofilling (PALF) has been
advocated by some as a viable alternative to standard limited fasciectomy

A

t

73
Q

Benefit of lipoaspirate (lipojilling)

A

■ Reduction in myofibroblast density and cell-to-cell contact
■ Inhibition of myofibroblast proliferation mediated by adiposederived stem cells
■ Prevention of recurrence by replacing the deficient subdermal fat

74
Q

risk of surgery dramatically increases for each subsequent
surgery on a digit

A

T

75
Q

risk of nerve injury in
a primary limited fasciectomy operation is around ……….

A

3%

76
Q

Percentage of some disturbance of sensation

A

68%

77
Q

For patients with early,
severe recurrence, PIP arthrodesis is one option that can stabilize the finger

A

T

78
Q

Amputation is considered only as a last resort in DD

A

T

79
Q

Chronic pain can decrease with an amputation of the involved digit.

A

F Phantom sensation
and phantom pain after surgery cannot be predicted easily, and sometimes pain related to complex regional pain syndrome is not eliminated with an amputation ofthe involved digit.

80
Q

needle aponeurotomy
has early results equivalent to fasciectomy for cases of mild contracture, but may not be as effective for contractures involving the PIP
joint.

A

T

81
Q

limited fasciectomy has better durability, but greater
short-term disability, compared to the minimally invasive options

A

T

82
Q

Salvage Procedures

A

■ Arthrodesis
■ Amputation

83
Q

the Delphi method to establish a definition of
recurrence in 2014

A

They defined recurrent contracture as passive extension deficit ofmore than 20° for at least one treated joint, in the presence
ofa palpable cord, compared to the result obtained at time 0. Time O was
further defined as between 6 weeks and 3 months after an intervention

84
Q

The Cleland ligaments are not typically
involved in Dupuytren contracture. The oblique retinacular
ligament is a component of the extensor mechanism and is not
involved in Dupuytren disease

A

T

85
Q

enzyme CCH (collagenase Clostridium
histolyticum) preferentially targets collagen types I and III, but
has less effect on collagen type IV

A

T

86
Q

This isimportant because type
IV collagen is a major structural component of the connective
tissues surrounding arteries, veins, and nerves.

A

T

87
Q

The structures that contribute to the spiral cord
include the pretendinous band, spiral band, lateral digital sheet,
and Grayson ligament

A

T

88
Q

Although cigarette smoking has been associated
with increased prevalence of Dupuytren disease, it has not been
linked to Dupuytren diathesis,

A

T

89
Q
A

Plastic Surgery( Grabb)Ali jasim (92 decks)

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