Dupuytren's contracture. An electron microscopic, biochemical, and clinical correlative study

Fascial specimens were obtained from twenty-four patients treated operatively for Dupuytren's contracture. The nodules and cords were examined by electron microscopic and biochemical techniques. The clinical course and response to operative treatment were then correlated with the tissue findings. Electron microscopic analysis revealed myofibroblasts in the nodules of seven of twenty-four patients. Fibroblasts containing prominent microtubules were found in ten patients. The fascia contained type-III collagen, increased amounts of collagen per unit of dry weight, and an increase in reducible cross-links of collagen. While the nodules were noted to contain a greater increase in reducible cross-links than the cords, there was little variation in the biochemical findings from patient to patient. Clinical recurrence was not related to the age of the patient at onset, duration, or severity of disease. Recurrence was related to the electron microscopic findings of myofibroblasts in the nodules and fibroblasts containing prominent microtubules in the fascia of these patients.