VandeBerg J S, Rudolph R, Gelberman R, Woodward M R
Plast Reconstr Surg. 1982 May;69(5):835-44. doi: 10.1097/00006534-198205000-00021.
The interface of skin and nodule or cord was studied in Dupuytren's contracture in 11 patients using light and electron microscopy. Four distinct anatomic zones were seen in he skin/nodule specimens, with three zones in skin/cord. Skin/nodule specimens had a striking horizontally layered dense band just underneath the dermis, a feature not found in skin/cord specimens. Electron microscopy showed active contractile fibroblasts (myofibroblasts) in the lower two zones in skin/nodule, with clusters of active and degenerating cells side by side. No myofibroblasts were seen in either the skin/cord or any skin specimen. These data suggest that the nodule is the active source of contraction in Dupuytren's contracture. Skin overlying both nodule and cord appears to be drawn passively by underlying contraction forces. A local defect in palmar skin may prevent normal inhibition of myofibroblast contraction. More aggressive resection of fascia and dermis may be indicated in skin/nodule areas.
运用光学显微镜和电子显微镜，对11例掌腱膜挛缩症患者的皮肤与结节或条索的界面进行了研究。在皮肤/结节标本中可见四个不同的解剖区域，而在皮肤/条索标本中有三个区域。皮肤/结节标本在真皮下方有一条明显的水平分层致密带，这一特征在皮肤/条索标本中未发现。电子显微镜显示，在皮肤/结节的下方两个区域有活跃的收缩性成纤维细胞（肌成纤维细胞），活跃细胞与退变细胞并排成群。在皮肤/条索标本或任何皮肤标本中均未见到肌成纤维细胞。这些数据表明，结节是掌腱膜挛缩症中收缩的活跃来源。覆盖在结节和条索上的皮肤似乎是被下方的收缩力被动牵拉。手掌皮肤的局部缺陷可能会阻止对肌成纤维细胞收缩的正常抑制。在皮肤/结节区域可能需要更积极地切除筋膜和真皮。
