Understanding Dupuytren’s Fasciectomy: A Surgical Solution for Contracted Fingers
Dupuytren’s Contracture is a gradual hand condition that affects one or more fingers as they bend towards the palm and can no longer be straightened. This is caused by the thickening of fibrous tissue, which underlies the skin, creating cords that pull the fingers into the palm. For some people, they only have mild symptoms, while others can find simple daily tasks such as gripping objects or shaking hands ever more difficult.
If non-surgical treatment is not helping or is not appropriate for you, a Dupuytren’s Fasciectomy, which is an operation to remove the tissue, may be suggested.
In this blog post, we’ll cover what Dupuytren’s Contracture is, when you might need surgery for it, and what to expect from a fasciectomy.
What is Dupuytren’s Contracture?
Disease description – Dupuytren’s Contracture is a fibroproliferative condition, which is characterised by an overproduction of fibrous tissue in the palm and fingers. This causes thick, nodular ropes to develop in the palm that pull the fingers, usually the ring and little fingers, into a flexed position.
Symptoms and Severity
- Early stage: Small lumps or nodules in the palm.
- Development: Cords are progressing, limiting finger movement.
- Severe cases: Fingers stay bent and cannot be used well.
Although typically not painful, it may severely affect gripping, writing, and other fine motor activities. If your fingers are becoming stiff and more curled, it’s best to seek medical attention and explore treatment options.
Treatment Options Overview
Non-Surgical Treatments: Doctors may suggest non-surgical treatments before contemplating surgery, especially in mild cases:
- Radiation therapy – May be useful in the early disease stage to help prevent progression.
- Needle Aponeurotomy (NA) – A procedure in which a needle punctures the taut cords.
- An enzyme injection called collagenase (Xiaflex®) breaks down fibrous tissue.
When Is Surgery Necessary?
Not all cases of palmar fibromatosis need to be treated, but when intervention is necessary, the condition can be treated with a fasciectomy. Studies have shown that when:
✔ Conservative treatments are not effective
✔ Severe finger contracture (*30 degrees)
✔ There is severe impairment to hand function
What is Dupuytren’s Fasciectomy?
If the finger does not straighten, referred to as a swan neck deformity, a full-blown contracture may occur, leading to surgery with the removal of the diseased fascia (Fasciectomy). There are two main types:
- Fasciotomy – Removes the diseased tissue only (most common, limited).
- Radical Fasciectomy – Excision of all palmar fascia (very rare; used in extreme cases only).
Anaesthesia Used
It may be carried out with the following:
- Local anaesthesia (numbs the hand only).
- Regional anaesthesia (numbing the whole arm).
- Most complex cases will require general anaesthesia.
The Surgical Procedure: What to Expect
Before Surgery
- A preoperative evaluation to make certain you’re healthy enough for surgery.
- Some medications, including blood thinners, may require you to cease taking them.
During Surgery
- Cut: at the middle of the little finger and palm.
- Debridement of tissue – The tight cords are meticulously cut away.
- Skin grafts (if necessary) – In some severe cases, extra skin to cover the wound may be necessary.
- Closing the incision: Staples or stitches are used to close the incision.
The surgery generally takes from 1 to 2 hours, with a brief recovery time, and then you’re ready to head home.
Recovery and Aftercare
The recovery after surgery varies, but here’s a general rule of thumb:
Immediate Aftercare
- Elevation of the hand to help with swelling.
- Protective splints or dressings for the hands.
- Pain management with painkillers prescribed by the doctor.
Hand Therapy & Physiotherapy
- Exercises for mobility and more permanent relief. The following exercises are examples of classes of workouts that can be accomplished to alleviate pain.
- Increasingly tougher exercises.
- Follow up to monitor healing.
Expected Recovery Time
- Initial healing: 2–4 weeks.
- Complete healing: 3-6 months (depending on severity).
Possible Complications
While rare, risks include:
- Infection.
- Nerve or blood vessel damage.
- Recurrence of contracture.
Is Fasciectomy Right for You?
If you’re dealing with symptoms of Dupuytren’s Contracture regularly, a fasciectomy may be the answer. The best way to find out is to see a hand specialist who can diagnose:
✔ How bad your case is.
✔ Hand function restrictions.
✘ Appropriate course of treatment.
Conclusion
Dupuytren’s Fasciectomy is a very effective operation for improving hand function when Dupuytren’s contracture is more severe. If you’re losing the fight against curled fingers and limited mobility, don’t wait to get help; early intervention can impact the outcome.
Get in touch with Chase Lodge Hospital today to arrange a consultation with one of our experienced hand surgeons and discover treatment options.
