Dupuytren's Fasciectomy

Dupuytren's fasciectomy is a surgical procedure used to treat Dupuytren's contracture, a condition that affects the fascia, a layer of tissue beneath the skin of the palm. The procedure involves removing the thickened and contracted fascia to restore normal movement and function to the hand.

What is Dupuytren's Contracture?

Dupuytren's contracture is a condition that causes one or more fingers to bend into the palm, making it difficult to straighten them. It occurs when the fascia in the palm thickens and contracts, forming nodules and cords that pull the fingers towards the palm.

Causes of Dupuytren's Contracture

The exact cause of Dupuytren's contracture is not known, but it is thought to be related to:

• Genetics: Family history plays a role in the development of Dupuytren's contracture.
• Age: The condition typically affects people over the age of 50.
• Sex: Men are more likely to develop Dupuytren's contracture than women.
• Diabetes: People with diabetes are at higher risk of developing Dupuytren's contracture.
• Smoking and alcohol consumption: These habits may contribute to the development of Dupuytren's contracture.

Symptoms of Dupuytren's Contracture

The symptoms of Dupuytren's contracture include:

• Nodules or lumps in the palm
• Cords or thickened tissue in the palm
• Bending of one or more fingers into the palm
• Difficulty straightening the affected fingers
• Pain or discomfort in the palm or fingers

The Fasciectomy Procedure

A fasciectomy is typically performed under local or regional anesthesia. The procedure involves:

• Making an incision in the palm to access the affected fascia
• Removing the thickened and contracted fascia
• Cutting any cords or nodules that are pulling the fingers into the palm
• Closing the incision with sutures or staples

Types of Fasciectomy

There are several types of fasciectomy, including:

• Open fasciectomy: This is the most common type of fasciectomy, where a single incision is made in the palm.
• Percutaneous fasciectomy: This involves making multiple small incisions in the palm to remove the affected fascia.
• Needle aponeurotomy: This is a minimally invasive procedure that uses a needle to cut the cords and nodules in the palm.

Risks and Complications of Fasciectomy

As with any surgical procedure, there are risks and complications associated with fasciectomy, including:

• Bleeding or hematoma
• Infection
• Nerve damage
• Tendon damage
• Recurrence of Dupuytren's contracture

Recovery and Rehabilitation after Fasciectomy

After a fasciectomy, the hand is typically wrapped in a bandage or splint to protect it during the healing process. Physical therapy may be necessary to restore movement and function to the hand.

• Pain management: Pain medication may be prescribed to manage discomfort after surgery.
• Wound care: The incision site should be kept clean and dry to promote healing.
• Hand therapy: A physical therapist can help improve range of motion, strength, and function in the hand.

Outcomes and Prognosis after Fasciectomy

The outcome of a fasciectomy depends on several factors, including the severity of Dupuytren's contracture, the type of procedure performed, and the individual's overall health. In general:

• Most people experience significant improvement in hand function and movement after surgery.
• The recurrence rate for Dupuytren's contracture is around 20-30%.
• Some people may require additional procedures or treatments to manage ongoing symptoms or complications.