Having a Dermofasciectomy

Dermofasciectomy is recommended usually only if the Dupuytren’s disease is particularly extensive, or if it has come back after a fasciectomy. It is the most extensive of the operations for Dupuytren’s disease.

Is the procedure always necessary?

There are other alternatives to having a dermofasciectomy which can be discussed with the surgeon before making a final decision:

• Doing nothing! – this is a very reasonable choice, because Dupuytren’s disease is a benign and harmless condition, despite it limiting what you can do with your hand.
• Fasciectomy – this is another type of operation to remove the diseased tissue from the finger, but does not remove any skin. The disease has a higher chance of coming back after a fasciectomy in some cases.

What is a dermofasciectomy?

In a dermofasciectomy, the surgeon removes most of the skin and underlying tissue from the palm side of the finger without damaging the tendons or nerves to the finger. A piece of skin is then cut from further up the arm, and used to cover the area where the skin has been removed on the finger.

What happens on the day of surgery?

On the day of the operation, you will be asked to report to XXXXXXXXXXXXXl. Please be aware that you will need someone to pick you up from the hospital after your operation.

What should you do to prepare?

Read about Having an operation on your hand or arm. This runs through most of the risks involved with the surgery, and it is really important that you are aware of this risk before agreeing to the surgery. It is important to remove all jewellery from your hand and wrists.

Planning for when you get home is also important. Although there are no restrictions on how you use your hand after the surgery, your hand will not work the way you want it to in the first few weeks after the operation. You can help make things easier by:

• Making sure you have a good weeks supply of food and provisions in the house
• Having some ready meals or easy prep meals available
• Planning to wear loose fitting clothing such as joggers and t-shirts for the first few days

Although you should be able to use your hand to do things within the first week, it will take around 4-6 weeks before it feels like your own hand again.

What type of anaesthetic is used?

This type of surgery is done under a general or regional anaesthesia as a day-case procedure. General anaesthesia means that you will not be awake for the operation whereas regional anaesthesia implies that it will just be your arm that is completely numb but you are awake during the surgery. Patients who are not medically suitable for general anaesthesia will be offered a regional anaesthetic. You will be seen by our pre-assessment team before your operation who will discuss these options with you.

What exactly does the surgeon do?

The surgeon’s job is to remove the thickened band or cord in the ligament which is causing the finger to curl towards the palm, as well as the overlying skin. This allows the finger to become straighter. A skin graft is then put over the finger where the diseased skin has been removed. The skin graft is used for the finger only – not the palm. We often use an ‘open palm‘ technique in Gloucestershire. This means that we do not stitch up the wound in the palm. The open palm wound heals beautifully, and leaves a fine scar despite the early appearance. A dressing and a plaster cast is applied for around 10 days after the surgery.

After the operation

What happens next?

After the procedure, you will be advised to keep your hand elevated above shoulder height, to ease pain and swelling over the first 2 days after surgery. This is most easily done by lying out on a sofa and resting the arm up on pillows. The hand will usually be bandaged with a plaster for around 10 days after the operation.

• It is really important to keep your elbow and shoulder all working normally during the first couple of weeks after surgery while the plaster is on.
• Most people do not need any special physiotherapy after dermofasciectomy, but our therapists are usually on hand to give advice if necessary.

Follow-up

Our nursing staff and therapists will see you on a regular basis until the wounds have healed and you are able to manage the post-operative exercises on your own. This is usually around 2-4 weeks after the surgery. You may find that there is some residual swelling to the hand, but this will gradually settle and you should continue to use your hand normally.

At this point we usually put you in charge from here on in – if you need to see us, you can contact us as you feel necessary.

Are there any complications of a dermofasciectomy?

There are many potential complications with this type of surgery, the most common reason for people not to be happy with the outcome is early recurrence of the contracture, either from difficulty mobilising the finger or from a severe scar reaction in the finger.

Other problems are outlined here:

• Incomplete Correction – sometimes, despite removing all the disease, the joint does not come out straight. The surgeon will have to make a decision on whether to release the joint or not. They will discuss this with you before the operation if they think there is a risk of incomplete release.
• Infection – infection is a complication of all operations. A course of antibiotics may be required.
• Damage to nerves – taking away the disease from around the small nerves to the finger can make the nerves stop working normally after the operation, although this usually gets better over the course of a few months. Occasionally, the nerve is divided accidentally, and this is more common if there has been a previous operation on the same finger. This usually leaves a permanent patch of numbness in the fingertip.
• Damage to the arteries of the finger – removing the disease from around the arteries may damage or divide the artery. The finger usually copes well if one of the arteries is damaged. If both arteries are damaged, then there is a risk of losing the finger.
• Scar problems – it is common for the scars to become raised, lumpy, red and tender for several months after surgery. This will gradually settle but rarely can give persistent issues.
• Stiffness – it is usually very safe to mobilise the hand as soon as the plaster is removed. All hands are stiff after coming out of a plaster cast, and it can be very hard work getting the movement back in the hand after this operation.
• Skin Graft Failure – it is quite common for small areas of the skin graft to fail but less commonly does the whole graft fail. In these circumstances often the wound needs to be treated with dressings for a bit longer.
• Recurrence – there is, as yet, no cure for Dupuytren’s disease and despite any release or surgery, it is likely to recur over the course of a few years. However, it is a benign condition and can be safely left untreated.

Other general complications of surgery are outlined on our Having an operation page.