144 CLINICAL APPLIED ANATOMY. 



drag inwards small islets of skin and so to form deep narrow pits, 

 into which often nothing larger than the head of a pin can be 

 passed. The deep surface of the fascia is quite smooth, and 

 overlies the tendons. 



As the fascia proceeds towards the digits it broadens out, and 

 at the heads of the four inner metacarpal bones it divides into 

 four slips, one of which passes to the root of each finger. Here 

 it is connected with transverse fibres, constituting the superficial 

 transverse inter-metacarpal ligament ; it then divides into two, 

 passing on either side of the digits to blend with the fibrous 

 sheaths of the flexor tendons. 



Contraction of this central part of the fascia and particularly 

 its inner portion gives rise to " Dupuytren's contraction of the 

 palmar fascia." One or more of the digital processes of the fascia 

 becomes for some reason contracted, and the resulting deformity 

 is characteristic. First, the finger connected with the shortened 

 process is flexed more or less markedly at the metacarpo- 

 phalangeal joint, with often the terminal phalanx slightly flexed 

 upon the second. Greater flexion of the affected digit can be 

 brought about, but active or passive full extension is impossible. 

 The little and ring fingers are the most frequently and the first 

 to be contracted. Secondly, when forcible efforts are made to 

 extend these fingers, very distinct bands of fascia stand out 

 under the skin of the palm, and the pits which have already 

 been mentioned become increased in depth. 



Operative treatment is generally indicated, and may consist of 

 either multiple subcutaneous division of the contracted bands or 

 their exposure and removal by dissection. Strict asepsis is 

 essential for the success of such operative measures, whether 

 open or subcutaneous. The flexion of the fingers, sometimes 

 extreme, and the creases and pits in the skin of the palm render 

 cleansing peculiarly difficult. Thorough scrubbing of the opposed 

 surfaces and the depths of the depressions is almost impossible, 

 so that it is desirable to soak the hand in an antiseptic solution 

 for a lengthened period before operation is undertaken, in order 

 that all parts may be reached by the germicide. 



