[Goyrand J.G.B (1803-1866), surgeon and academician from Aix en Provence]. / J.G.B. Goyrand (1803-1866), chirurgien et académicien Aixois.

The authors present Jean-Gaspard-Blaise Goyrand, from Aix, who is not simply remembered for his description of the wrist fracture which has retained his name. His theses concerning permanent retraction of the fingers, presented to the Royal Academy of Medicine in 1833 and 1834, were contrary to those proposed by Dupuytren and proved to be completely accurate. All of Goyrand's work was edited by Masson in 1870, including a superb case report of giant elephantiasis of the penis and scrotum, a study on cleft lip and the technique of using collodion bands to close large wounds [corrected].

Regression of Dupuytren's contracture.

The phenomenon of clinical regression of Dupuytren's contracture is described and discussed. It is already recognized and used in fasciotomy where it follows the release of longitudinal tension. The quite extraordinary resolution produced by continuous passive skeletal traction in extension is presented. Regression beneath grafted skin is described and discussed with its clinical implications. The generally accepted view of Dupuytren's contracture being "irreversible" now presents a challenge for further clinical and pharmacological studies. The possibility of non-surgical control does exist.

Some medicolegal aspects of Dupuytren's contracture.

This article presents the medical and legal aspects of Dupuytren's contracture. It also presents a rational basis for the assessment of the relationship, if any, between a patient's occupation and the development of Dupuytren's contracture.

Unsatisfactory results in Dupuytren's contracture. Philosophies of Dr. J. T. Hueston.

Unsatisfactory results from surgery for Dupuytren's contracture usually arise from complications. The author considers the complications and their subsequent unsatisfactory results that are attributable to the surgeon and those that are attributable to the patient.

Aetiology of Dupuytren's contracture.

Dupuytren's contracture is a fascinating, deforming, fibrotic condition of the palmar fascia which has confounded clinicians and scientists for centuries. The aim of this paper is to place in perspective the longstanding associations of age, sex, race, hereditary factors, diabetes and alcohol consumption with the more recent novel investigations at the cellular level. In concert, the findings indicate that a number of factors may lead to the narrowing of palmar fascia microvessels, with localized ischaemia and oxygen free radical release. Oxygen free radicals are likely to damage the surrounding stroma, and stimulate fibroblast proliferation. Proliferating fibroblasts lay down collagen and contract in the lines of stress. The process is likely to encourage further microvessel ischaemia with a positive feedback effect that is consistent with the progressive nature of the condition.

A forgotten innovator in facial reconstruction: Pietro Sabattini.

Pietro Sabattini (1810-1864), a creative surgeon from Bologna, Italy, first had the idea of repairing a posttraumatic upper lip defect using a flap taken from the lower. The flap contains the three elements--skin, muscle, and mucosa--and is based on a specific vessel, the circumlabial artery. Therefore, it anticipates the musculocutaneous flap concept of today. Sabattini published his paper in 1838, 60 years before Abbé. This paper provides the first English translation of the original text and a biography of this forgotten innovator in facial reconstruction.

Cell-controlling factors in Dupuytren's contracture.

The search for the causative factors in Dupuytren's disease has historically progressed form gross anatomical dissection, through microscopical tissue studies, to the biochemistry of the collagen produced. But these elements are merely the end products of cellular activity - not revealing the factors responsible for the changes in cellular activity. Recent biochemical investigations suggest that a number of conditions including localized microvascular ischemia and high alcohol concentrations transform the "benign" xanthine dehydrogenase of endothelial cells to the oxygen-free radical-releasing xanthine oxidase. Oxygen-free radicals are highly reactive species with half-lives in the order of milliseconds capable of both damaging the surrounding peri-microvasculature and stimulating fibroblast proliferation. It is this stimulation of fibroblast proliferation in the palmar fascia that is the key event in the pathogenesis of Dupuytren's contracture.

Occurrence of Dupuytren's disease beneath a full thickness skin graft: a semantic reappraisal.

Recurrence beneath a Wolfe graft is reported and discussed. While the dermofasciectomy appears able to inhibit myofibroblast proliferation where the graft is in direct contact with the graft bed, it is possible that, in the finger, the narrow strip behind the neurovascular bundle may, very rarely, escape this control and proceed to extension in depth.

The personality of hand surgeons.

The aim of the present study was to investigate some aspects of motivation to practise hand surgery, psychological mindedness and personality characteristics in a group of 212 Hand Surgeons. The data was obtained by administering the Eysenck Personality Inventory, an especially constructed questionnaire, in a group setting at two conferences in Australia.

The extensor apparatus in Dupuytren's disease.

If we study the secondary changes in the extensor mechanism we can see changes at each of the three joint levels which are responsible for incomplete correction of the deformity after apparently adequate surgery on the palmar aspect. At the DIP level the flexion may not be restored until tenotomy of this secondarily contracted extensor tendon is performed. At the PIP level the middle slip may be used as a "lively splint" capable of progressive post-operative straightening of this joint if tenotomy over the middle phalanx is used. At the MP joint of the little finger ulnar subluxation of the extensor tendons may produce persistent MP flexion although passively correctable, and relocation of the extensors at this level may occasionally be indicated to correct this persisting disability.

'Firebreak' grafts in Dupuytren's contracture.

The empirical observation that Dupuytren's Contracture does not recur beneath a skin graft is applied as a means of controlling recurrent Dupuytren's Disease. In those patients with a strong inherited diathesis to the production of Dupuytren's Contracture, recurrence may occur or even by anticipated, and the placement of a skin graft strategically at a flexion crease is shown to act as a 'firebreak' between areas of potential flare-up of recurrent Dupuytren's Disease.

Some observations on knuckle pads.

Although knuckle pads are histologically similar to the palmar nodules in Dupuytren's Disease, they do not produce contraction. By considering the anatomical situation of the knuckle pad overlying the joint line and comparing it with a unique case of a dorsal nodule occurring between the joint lines, an explanation is profferred for this lack of contraction by knuckle pads. That contraction in the extensor mechanism was produced by the nodule between the joint lines is used to support further the "extrinsic" hypothesis of the pathogenesis of Dupuytren's Disease.

Dermofasciectomy for Dupuytren's disease.

The empirical observation that skin replacement by free skin grafts prevents recurrence of Dupuytren's disease is applied here to the treatment of recurrent Dupuytren's disease. In young patients with a strong "Dupuytren's diathesis," this technique of skin excision along with the fascia is used prophylactically as the primary treatment.

Current state of treatment of Dupuytren's disease.

On overview is present which briefly summarizes the incidence, pathology and natural progress of Dupuytren's Disease. The importance of recognizing the Dupuytren diathesis in planning the surgical treatment, the importance of conservatism in initiating surgery, and the principles of surgical management including dermofasciectomy are presented, and it is once again stressed that a distinction exists between recurrence and extension of Dupuytren's Disease post-operatively.