We know through experience that the decision to have a fasciectomy is generally preceded by a long decision making process. With this information we would like to help you with this process, by advising you about the procedure itself and the possibilities and risks involved with this operation. This advice, does not however, replace the need for an extensive personal consultation with your surgeon who will thoroughly address your specific questions.
When is a fasciectomy necessary?
What is the aim of a fasciectomy?
What do I have to consider before a fasciectomy (pre-operative phase)?
What do I have to consider after a fasciectomy (post-operative phase)?
What are the possible risks with a fasciectomy?
Which result can I expect after a fasciectomy and what are the chances of success?
The Dupuytren’s contracture is a disorder of the palm fascia and occurs mostly after the age of 40. The predisposition to this disease is genetically determined and can be caused by additional factors such as repeated injuries, localised infections, mechanical irritations, liver damage, diabetes mellitus etc.
The disorder leads to a hardening and knot building in the area of the palm and fingers, which can result in a functional limitation of finger movement. Men are 6 times more likely to be affected by this disorder than women.
The aim of a fasciectomy is to remove any diseased tissue, as the Dupuytren’s spreads both towards the skin and deep into the muscles and between the vascular nerve bundles. A radical removal of Dupuytren’s tissue is not usually possible because important structures of the hand, such as vascular nerve bundles, muscles and skin must be protected. Small remains of Dupuytren’s tissue could therefore be left behind after every surgery.
Procedure. An incision is made along the natural skin folds in the hand and over the joints in a zigzag form. The incision in closed with fine stitches after a soft drain has been inserted.
Type of anaesthesia. The surgery is usually performed under general anaesthetic or plexus anaesthetic.
There is no special preparation needed. Information on general measures and the necessary preliminary examinations will be put together for you personally in a pamphlet which you will receive at your consultation.
The drain is removed 2 days after surgery and the stitches after 2 weeks. For several days a fist bandage must be worn which is usually replaced after 2 to 5 days with a lighter dressing. The operated hand should be kept elevated during sleep for 1 week and not allowed to hang down when getting up.
Recovery. After a fasciectomy the hand must be rested for 2 to 3 weeks which means that the tight gripping or lifting of heavy objects should be avoided. Moving of the fingers without applying any strain is possible, after consultation with your surgeon. Heat sources, such as those from saunas should be avoided for the first 6 weeks after surgery.
No procedure is without risk. The general risks of surgery include the possibility of bleeding, thrombosis and infection. Specific risks associated with a fasciectomy are impaired wound healing, especially in advanced Dupuytren’s, caused by circulation problems in raised skin areas. If the disorder is at an advanced state, a complete elimination of functional symptoms is not always possible. Because Dupuytren’s can not be removed radically, there is always the possibility of regrowth of the tissue within the following months or years due to relapse. Sensation problems and restrictions in the joints of the finger may last for a long period of time.
Freedom of movement. By removing the thickened connective tissue of the palm of the hand, mobility and function are in most cases improved or restored. If the disorder has been present for a long time and there is a significant restriction of finger movement, then through the surgical procedure, at least better function can be achieved.