Ultrastructural relationship of skin to nodule and cord in Dupuytren's contracture

The interface of skin and nodule or cord was studied in Dupuytren's contracture in 11 patients using light and electron microscopy. Four distinct anatomic zones were seen in he skin/nodule specimens, with three zones in skin/cord. Skin/nodule specimens had a striking horizontally layered dense band just underneath the dermis, a feature not found in skin/cord specimens. Electron microscopy showed active contractile fibroblasts (myofibroblasts) in the lower two zones in skin/nodule, with clusters of active and degenerating cells side by side. No myofibroblasts were seen in either the skin/cord or any skin specimen. These data suggest that the nodule is the active source of contraction in Dupuytren's contracture. Skin overlying both nodule and cord appears to be drawn passively by underlying contraction forces. A local defect in palmar skin may prevent normal inhibition of myofibroblast contraction. More aggressive resection of fascia and dermis may be indicated in skin/nodule areas.