Dupuytren's contracture; a new concept of the pathogenesis correlated with surgical management.

1. A new concept of the pathogenesis of Dupuytren's contracture has been presented together with a plan of therapy based upon this concept. In the disease process three stages can be identified: the proliferative stage; the involutional (contracting) stage; and the residual stage. 2. In a hand with nodules in the proliferative or involutional stage, the sites and approximate degree of potential future flexion contractures can be predicted. 3. Operations, based upon the stage of the pathological process, were carried out, during a ten-year period, on 206 hands of 154 patients. The over-all results were: good in 164 (79.6 per cent), fair in twenty-nine (14.1 per cent), and poor in thirteen (6.3 per cent). 4. Selection and evaluation of therapeutic measures in Dupuytren's contracture should be based upon the stage of the disease existing at the time of the therapy. 5. The nodule is interpreted as the essential lesion; the fibrous cords are interpreted as hypertrophy of fascial hands reacting to intermittent tension stresses. Nodules require excision; the cords do not. 6. In the palm, the reactive fascial cords were sectioned by subcutaneous fasciotomy. In the fingers, the cords were sectioned (or a segment excised) by direct vision.