A study of Dupuytren's tissue with the scanning electron microscope.

This study was designed to determine if structural changes in the palmar fascia in Dupuytren's disease, as viewed by the scanning electron microscope, might provide some information about the pathogenesis of this disease. The palmar fascia from seven uninvolved hands and from 21 patients with Dupuytren's disease was examined. There were distinct differences between normal and diseased collagen. The diseased tissue showed collagen that was more tightly bound and had a shorter wave pattern. In the Dupuytren's tissue the waves were frequently in a helix, but this was never seen in the normal tissue. The most striking differences were noted in the nodule, presumably because it appears first, followed by the cord proximal to the nodule (pretendinous cord). Similar but less obvious changes were noted in the cord distal to the nodule (central cord) presumably because it is last to form. These observations suggest a mechanism of contraction. The short wave length and helix formation of the collagen indicate shortening. If the concept of the myofibroblast as a contractile cell is accepted, the contraction of these cells in stepwise fashion could produce the changes in the structure of the collagen that have been observed and result in joint contracture.