RESUMO
Increased amounts of plasminogen activator enzymes were found in the large Dupuytren's nodules in the so-called active phase of the disease. A prospective study in 15 patients who had operations investigated possible relationships between fibrinolytic capacity of the palmar nodules (assessed by the fibrin plate method) and the recurrence of contracture. There were substantial analogies and suggestive connections with the results of previous electron microscopic studies. Combined with the presence of myofibroblasts, the high increase of plasminogen activator enzymes in the fascial nodules may be regarded as a predictive marker for possible recurrence after surgical treatment of Dupuytren's contracture.
Assuntos
Contratura de Dupuytren/patologia , Fáscia/patologia , Deformidades Adquiridas da Mão/patologia , Ativadores de Plasminogênio/metabolismo , Complicações Pós-Operatórias/patologia , Adulto , Idoso , Contratura de Dupuytren/cirurgia , Feminino , Fibrinólise , Deformidades Adquiridas da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
Considering the proved interaction of fibrin with fibroblasts and the seemingly decisive role of structural and functional changes ("modulation") of these cells in the evolution of Dupuytren's contracture, research has been carried out in order to investigate the fibrinolytic capacity and the possible presence of fibrin/fibrinogen in the palmar fascia of subjects operated upon for Dupuytren's Disease. Fibrin/fibrinogen were detected by a direct immunofluorescence technique and fibrinolytic activity was assessed by a fibrin plate method. A remarkable decrease of fibrinolytic activity and the presence of fibrin/fibrinogen were observed in small nodules in the early stage of disease, whereas large nodules showed a high amount of plasminogen activator enzymes. Small nodules seem to form and increase by progressive adhesion of fibroblasts to the polymerizing fibrin, while high fibrinolytic activity of large nodules probably results from "modulation" of many fibroblasts into contractile myofibroblasts and could therefore be considered as a biochemical sign of the evolutionary phase of Dupuytren's contracture.
Assuntos
Contratura de Dupuytren/metabolismo , Fáscia/análise , Fibrina/análise , Fibrinogênio/análise , Fibrinólise , Adulto , Contratura de Dupuytren/fisiopatologia , Mãos , Humanos , Pessoa de Meia-IdadeRESUMO
The use of an extensive fascio-cutaneous flap with skin from the thorax and abdomen, starting from the lateral and subscapular area behind the posterior axillary line and going down to the homolateral pubic and inguinal area, is described. This type of flap is used for repair of very extensive skin loss on the thorax when free grafts, the only alternative, are unsuitable because of the need for more effective and definite covering.
