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Hand Surgery

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Dupuytren disease

The most important research line of the Department of Plastic Surgery is related to Dupuytren disease. Dupuytren disease is a chronic hand condition, in which nodules are formed in the palmar fascia of the hand. The nodules can progress into cords that may contract, resulting in a permanent flexion deformity of the affected finger. This often leads to functional complaints. The cause of the disease is largely unknown, but small steps are taken towards a better understanding of the disease mechanism. Dupuytren disease can be treated by dissection or resection of the diseased tissue, resulting in better hand function. However, there is no treatment that influences the cause of the disease, so that prevention is not (yet) possible.

During the past years, the Department of Plastic Surgery initiated a large study coordinated by plastic surgeon Guido Dolmans, PhD, on the genetic background of Dupuytren disease. This study was done in cooperation with medical centers in the Netherlands, England and Germany. Several genome loci were identified to be involved with Dupuytren disease, indicating that genes from the Wnt signaling pathway play an essential role in the disease pathology. Evert-Jan ten Dam currently works on a PhD-thesis that continues this research project His thesis focuses on the cell biological processes, including Wnt signaling, that form the origin of Dupuytren disease and associated fibromatoses. This leads to a better understanding of the pathology, and provides valuable information on possible starting points of future treatment options.

Our Department has been involved in various research projects concerning surgical treatment of Dupuytren disease. Plastic surgeon Annet van Rijssen, PhD, prospectively compared two commonly used treatment options: percutaneous needle fasciotomy (dissection of the cord using a needle) versus limited fasciectomy (resection of the diseased tissue). It was found that limited fasciectomy provides a more durable result than percutaneous needle fasciotomy. However, percutaneous needle fasciotomy also demonstrated several advantages compared to limited fasciectomy: quick recovery, and a low chance of complications. She concluded that percutaneous fasciotomy is a valuable alternative for the treatment of recurrent disease, since more invasive procedures can be delayed. The Department of Plastic Surgery has also been involved in a small study on the effectiveness of collagenase for treating the first web space in Dupuytren patients.

Rinze Zwanenburg started in 2011 with his PhD, to further investigate the anatomy of Dupuytren disease. Despite the fact that the condition has first been described in the early 17th century, the pathoanatomy is largely unexplored. This knowledge can contribute to a successful treatment, since many treatment options require detailed knowledge about the anatomy.

The department of Plastic Surgery is also involved in research about epidemiological aspects of Dupuytren disease. PhD graduate Rosanne Lanting determined the prevalence of Dupuytren disease in the general elderly population of the city of Groningen, which was 22%. Furthermore, she investigated disease patterns and started a study to follow the course of Dupuytren disease. The latter is a longitudinal cohort study including 262 Dupuytren patients with various disease stages. Every 6 months, the hands of the participants are examined to record the disease progression in detail. This study is currently coordinated by PhD candidate Dieuwke Broekstra, and it data-collection is still going on. Eventually, the data of this study will be used to identify factors that predict the course of the disease.

Sanne Molenkamp recently started her PhD on ultrasonography in Dupuytren disease. There are a few studies that indicate that ultrasonography is a valuable tool in providing information about the pathoanatomy of Dupuytren disease preoperatively. This way, complications can be prevented and it might be possible to obtain a better surgical result. Furthermore, it has been suggested that disease activity can be visualized using ultrasonography. If this is correct, it might be possible to predict disease progression using ultrasonography.

Theses from PhD graduates of our department on Dupuytren disease, can be downloaded from the links below.

PhD thesis of Guido Dolmans

PhD thesis of Annet vanRijssen

PhD thesis of RosanneLanting

PhD thesis of Dieuwke Broekstra

Ulnar nerve entrapment

Ulnar nerve entrapment, also known as cubital tunnel syndrome, is an entrapment neuropathy of the ulnar nerve at the elbow. Ulnar nerve entrapment is, after the carpal tunnel syndrome, the most common neuropathy of the peripheral nervous system. This often leads to paraesthesia, pain, muscle atrophy, and functional restrictions. These complaints can be eased by surgical release of the ulnar nerve. In some cases the complaints reduce after a period of rest.

Plastic surgeon Mike Rüttermann investigates the recovery of the ulnar nerve after endoscopic surgical release. In this study, patients are followed for 1 year after the surgical treatment, to determine how the ulnar nerve recovers. The nerve is visualized with a 22 MHz ultrasound probe, and the ultrasonography findings are compared to electrophysiological findings. It is the first time that an ultrasound probe with such a high resolution has been used in this field. This is why Mike Rüttermann also determines the added value of this 22MHz probe with a 15 MHz probe, which is commonly used.

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