Observations on contraction of the fingers (Dupuytren's contraction) : and its successful treatment by subcutaneous divisions of the palmar fascia, and immediate extension also on the obliteration of depressed cicatrices after glandular abcesses, or exfoliation of bone by a subcutaneous operation / by William Adams.

  • Adams, William, 1810-1900.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Observations on contraction of the fingers (Dupuytren's contraction) : and its successful treatment by subcutaneous divisions of the palmar fascia, and immediate extension also on the obliteration of depressed cicatrices after glandular abcesses, or exfoliation of bone by a subcutaneous operation / by William Adams. Source: Wellcome Collection.

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    e33 for division of tlie fascia, which had suggested itself to him, and observes :*— With regard to the mode of performing the operation, you are aware tliat for contraction of tendons, we generally endeavour, at the present time, to perform a subcutaneous incision, so that no air may enter the divided parts to inter- fere with union by the first intention ; and the parts having united to a certain degree, extension is then made, to separate the ends while the united sub- stance is still soft. Now I have turned over in my mind the propriety of acting thus in the present case, but I am inclined to think I shall not do so. You know that the great risk of wounds and injuries about the plantar and palmar fascia, is from confine- ment of matter, which is then made to pass along the tendons of the muscles, and thus they form very troublesome cases. Now in order to remove the contraction in this case, it will be necessary to make several cuts ; the band of fascia must be divided in the palm before its separation to the two fingers, each finger must probably have another incision opposite to the joint, with the metacarpal bone, and very likely similar cuts must be made at the sides of each finger. To do this below the skin, which is inseparably joined to the fascia, must be at least very difiicult, and not without risk of the digital arteries and nerves being injured; and then, as the extension on a hand-splint must be considerable, I think it would be altogether impossible to escape suppuration in some of the several incisions. If the operation is done in this manner, and matter does form, it is necessarily confined, and may do much * Op. cit, p. 203. D