Fasciectomy

Overview

Dupuytren’s disease, also known as Dupuytren’s contracture, is a progressive connective tissue disorder that affects the hand. It causes the fascia, a fibrous tissue layer in the palm, to become thick and tight, leading to the curling of one or more fingers towards the palm. This condition can significantly limit hand function.

To address severely bent fingers caused by Dupuytren’s contracture, individuals may undergo a surgical procedure called a fasciectomy. During this procedure, an orthopaedic hand surgeon removes the thickened and tight fascia tissue in the palm. While surgery is not a cure, it can greatly improve the ability to straighten and move the affected fingers, restoring hand function.

Dupuytren’s disease may result from inherited genetic mutations or occur for unknown reasons. It typically starts with the development of nodules or small tissue lumps on the palm’s fascia, which eventually progress into thick cords of tissue that pull the fingers (and occasionally the thumb) towards the palm. Surgical fasciectomy is an effective treatment option for those with severe Dupuytren’s contracture, offering relief and improved hand mobility.

Types of fasciectomies

Fasciectomy procedures encompass various methods, each dependent on specific cases:

• Segmental (partial) fasciectomy: In this approach, surgeons create small incisions strategically placed within the natural creases of the hand. They then meticulously separate the thickened tissue from adjacent tendons and nerves, ultimately excising a short segment of the affected tissue cord.
• Subtotal palmar fasciectomy: This method involves a series of incisions, often arranged in a zigzag pattern, tracing the creases of the palm and fingers. The objective is to remove as much diseased tissue as possible. In some instances, a skin graft may be necessary to facilitate wound healing.
• Dermofasciectomy: Specifically designed for recurrent Dupuytren’s contracture, this procedure entails the removal of both diseased fascia tissue and a portion of the skin from the palm. To aid in the healing process, a skin graft is typically required.

Reasons for undergoing the procedure

Dupuytren’s disease is a chronic and progressive condition. In the initial stages, non-surgical treatments are typically explored by your healthcare provider, which may involve injections of steroids or collagenase, an enzyme. However, if the condition advances to the point where your fingers experience severe bending, significantly impacting the functionality of your hand, your healthcare provider may initiate discussions about surgical interventions.

Surgical treatments for Dupuytren’s disease include the following options:

• Fasciotomy: This procedure involves your provider making a small incision in your palm and then separating the thickened cord of tissue. By dividing this tissue, its strength is reduced, which can improve your ability to bend and move your fingers.
• Percutaneous needle fasciotomy (Needle Aponeurotomy): In this method, a small needle is used by your provider to create perforations or holes in the thickened tissue. These holes weaken and break apart the tissue, thereby enhancing the mobility of your fingers.
• Fasciectomy (palmar fasciectomy): A fasciectomy is a surgical procedure that removes the nodules and cords of tissue responsible for pulling on your thumb and fingers, contributing to the condition’s progression.

Your healthcare provider will determine the most appropriate surgical approach based on the severity and progression of Dupuytren’s disease.

Risks

It’s typical to experience some numbness or loss of feeling in your fingers following a fasciectomy. As the constricted nerves start to extend, this short-term issue ought to get better. Very rarely, injury to surrounding blood vessels or nerves may result in irreversible loss of finger function. Amputation may be necessary for you.

The following are other possible fasciectomy side effects:

• Infections
• Bruising
• Swelling (edema)
• Anesthesia allergy
• Skin sensitivity and scars

Before the procedure

You should adhere to the pre-procedural guidelines provided by your surgeon. It could be necessary for you to:

• Stop smoking.
• Cease taking some drugs, such as herbal and vitamin supplements.
• Do not eat or drink anything before surgery (fasting)

During the procedure

A segmental fasciectomy is typically performed as an outpatient procedure, allowing patients to return home on the same day. Regional anesthesia may be administered to numb the upper body, and in some cases, the surgeon may opt not to use stitches, leaving a small wound open for natural drainage and healing while applying a bandage to minimize infection risks. On the other hand, subtotal palmar fasciectomies and dermofasciectomies are more complex and may necessitate skin grafts, often requiring general anesthesia for the patient to be asleep during the surgery. Due to the higher risk of infection associated with skin grafts, individuals undergoing these procedures may need to stay overnight in the hospital.

After the procedure

After undergoing surgery, it’s common to experience some post-operative symptoms such as pain, swelling, and stiffness. Additionally, you may encounter tingling or numbness in your hand and fingers, which could persist for several months. The duration of time you’ll need to take off work varies depending on your occupation, ranging from two to 12 weeks.

To ensure a smooth recovery, it’s essential to adhere to your healthcare provider’s recommendations, which may involve the following:

• Applying ice packs and keeping your hand elevated.
• Cleaning the surgical incision with soap and water, then covering it with a bandage.
• Ensuring your hand and stitches remain dry while showering.
• Engaging in physical therapy, including at-home exercises.
• Taking prescribed medications, such as antibiotics and pain relievers.
• Wearing a splint for a period of up to 12 weeks.

Outcome

While surgery doesn’t provide a cure for Dupuytren’s contracture, it can enhance hand function. Roughly 20% of individuals may encounter a reoccurrence of the condition following a fasciectomy, which may necessitate additional surgical intervention.

It is advisable to reach out to your healthcare provider promptly if you encounter any of the following symptoms:

• Severe muscle pain.
• Inability to sense or move your fingers.
• Allergic reactions, such as an itchy rash (contact dermatitis).
• Experiencing chest pain or breathing difficulties.
• Manifestation of signs of infection, like fever, yellow discharge, or red streaks.