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This procedure is designed to straighten the finger, and is something that people usually opt to do because of restriction in the function of the hand as a result of Dupuytren’s disease.

Is this procedure always necessary?

The alternative methods of management are:

  • Doing nothing! – this is a very reasonable alternative, because Dupuytren’s disease is a benign and harmless condition, despite the limitation of function.
  • Needle Fasciotomy – this is more suitable for milder disease particularly when there is a well defined band or cord within the palm of the hand.
  • Fasciectomy – This is an operation to remove the diseased tissue from the finger and allow it to straighten. It is a much bigger operation than needle fasciotomy, and is usually recommended in more severe disease.
  • Dermofasciectomy – For Dupuytren's disease, this operation is the biggest operation we do. The aim is to remove the Dupuytren’s tissue and overlying skin. This operation takes a long time to recover from, and is usually only recommended in severe or recurrent disease.

What is a fasciectomy?

This is a way of treating early Dupuytren’s disease by removing the thickened tissue that is causing the finger to curl towards the palm. This allows correction or straightening of the finger. Straightening the finger aims to allow in improvement in your hand function. This technique is suitable for moderate or severe disease.

What happens on the day of surgery?

On the day of the operation, you will be asked to report to the Day Surgery Unit. You can expect to be in hospital for most of the day, depending on the list order. Please be aware that you will need someone to pick you up from the hospital after your operation.

What should you do to prepare?

Having an operation on your hand or arm 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. You can 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?

We generally perform this type of surgery 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 prior to 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. The surgeon will make an incision in the palm and extend it to the affected digit. The Dupuytren's tissue will be identified and removed. This will allow the finger to become straighter. The wounds are either left open, partially closed or fully closed with sutures.

We often use an ‘open palm‘ technique. This means that we do not stitch up the wound in the palm, although the finger is always stitched. The open palm wound heals beautifully, and leaves a fine scar despite the initial appearance. A dressing and sometimes a plaster cast is applied for anything between 48 hours and 10 days following surgery, depending on what has been done.

If there is involvement of the disease within the skin, then sometimes the skin also requires excision (dermofasciectomy). In these cases, a skin graft may need to be taken, usually from the upper aspect of the forearm in order to cover the defect in the hand. This is only usually required in very severe or recurrent disease.

Rehabilitation and follow-up

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 following 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 up for the first few days after the operation. The bandages are replaced with light dressings as soon as possible to allow you to move your hand.

It is really important to keep your hand, wrist, elbow and shoulder all working normally during the first couple of weeks after surgery. If you have a plaster on, then concentrate on movement in the elbow and shoulder until the plaster is removed.
Most people do not need any special physiotherapy after fasciectomy, but our therapists are usually on hand to provide 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 following surgery and you should be gradually back to your normal activities. 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.

Are there any complications to a fasciectomy?

There are several complications associated with this type of surgery:

  • Incomplete Correction – Although the knuckle joint almost always comes straight, depending on the degree of contracture the first knuckle joint sometimes does not come straight. This can be from scarring of the normal tissues around the joint. Your 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 – Sometimes the nerves that supply sensation to the fingers are surrounded by he Dupuytrens disease. The disease is dissected from around the nerves but the nerves can get bruised or damaged during the procedure. This usually results in an area of temporary numbness to the digit
  • Damage to the arteries of the finger – Similarly the disease can also encase the blood vessels, and the dissection can cause damage to the vessels.
  • Scar problems – It is common for the scars to become raised, lumpy, red and tender for several months following surgery. This will gradually settle but rarely can give persistent issues.
  • Stiffness – It is usually very safe to mobilise the hand straight away, but sometimes stiffness sets in if the hand is not moved regularly.
  • 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