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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    practice, from the teacTiing of my late colleagues and predecessors at the Orthopaedic Hospital, Mr. Tam- plin and Mr. Lonsdale. They believed that both fascia and tendon were involved in the contraction, and divided the contracted cords in the palm of the hand in the same way as they divided tendons, sub- cutaneously cutting, from below upwards, and making only one puncture.* They also adopted the same method of after-treatment, by gradual mechanical extension, using steel instruments, with rack-and- pinion movements opposite the joints of the fingers, like that represented in Fig. 10. Further study of these cases, and the opportunity which was accidentally afforded me of seeing that the tendons were not involved in a severe case of finger- contraction previously referred to, in which the palm of the hand was torn across by a horse, confirmed me in the belief that the tendons were not imj^licated in this form of contraction of the fingers, and that surgically, we had to deal with contraction of the palmar fascia alone, as Dupuytren had described the affection. I therefore commenced the practice of making multiple subcutaneous divisions of the fascia and its digital prolongations, introducing the smallest tenotomy knife—smaller than any ordinarily in use—or fascia- knife, I prefer to call it, with a straight cutting edge terminating in a point, as shown in Fig. 5, and carrying it between the skin and the contracted cord, which I then divide by cutting downwards very slowly and cautiously, taking care not to dip the * On the Nature and Treatment of Deformities, by R. W. Tamplin, p. 262. London : Longman & Co, 18i6. E