Dupuytren's disease and the relationship between the transverse and longitudinal fibers of the palmar fascia: a dissection study.

Dupuytren's disease is characterized clinically by a proliferative fibrous contracture of the palmar or digital fascia. A logical approach to the assessment and treatment of this complex condition requires a precise knowledge of the anatomy of the palmar fascia. This dissection study was carried out on ten cadaveric hands to determine the relationship between the longitudinal and transverse fibers of the palmar fascia. We found that the deepest layer of the three longitudinal layers of the palmar fascia (layer 3) divided at the transverse fibers into two sub-layers. Fibers of the deeper sub-layer passed dorsally, proximal to the transverse fibers of the palmar fascia, whereas the more superficial fibers of layer 3 passed dorsally distal to the transverse fibers. The literature is reviewed and the significance of these findings is discussed in relation to the surgical treatment of Dupuytren's disease.