What is Dupuytren’s Fasciectomy?
Dupuytren’s disease is actually a condition in which the fibrous tissue of our hand which is called fascia gets affected. Fascia lies underneath the skin in the palm and finger and it leads to the thickening and tightening of fascia over time. Due to this condition, it seems that the fingers will be pulled inward towards the palm and condition is called Dupuytren’s contracture.(1) In some cases, it is found that Dupuytren’s contracture causes a problem in performing daily activities. To treat this condition, hand surgery is required which is called Dupuytren’s fasciectomy.
Symptoms of Dupuytren’s Contracture
The progress of Dupuytren’s contracture is very slow and it is formed over the year. When you develop Dupuytren’s contracture, you can observe the following symptoms:
- Nodules: One or more small lumps or nodules may develop in the palm of the hand. These nodules remain fixed to the underlying skin and in the initial period you may feel tenderness but with time this tenderness goes away. In some cases, the patient develops a deep indentation near the nodules.
- Cords: In some cases, the nodules thicken and forms dense and tough cords of tissue underneath the skin. It becomes problematic to straighten or spreading the finger and thumb.
When is Dupuytren’s Fasciectomy Necessary?
Generally, it is seen that the progress of Dupuytren’s contracture is very slow and it does not become troublesome even after many years. In some cases, it is also found the condition does not progress after developing lumps in the palm. However when the condition progresses the doctor may recommend non-surgical treatment for slowing the progress. In such a case, doctors may inject corticosteroid which is actually a kind of anti-inflammatory medicine. Though the effectiveness of corticosteroid varies from person to person, in most cases it slows the progress of Dupuytren’s contracture. In some cases, it is seen that the doctor uses the process of splinting. In this case, the nodules are forcefully stretched from the contracted fingers. However, this process cannot stop the progression of Dupuytren’s contracture rather it can cause injury to the finger or hand.
When the non-surgical treatment does not work and cannot stop the progression of Dupuytren’s contracture doctors suggest to go for the surgery i.e., for Dupuytren’s fasciectomy. Currently, there is no cure of Dupuytren’s contracture but with Dupuytren’s fasciectomy, it is only possible to reduce the condition and enhance the motion in the affected finger. Dupuytren’s fasciectomy can help to strengthen the finger as well as improve the other problems that are caused due to Dupuytren’s contracture. However, though Dupuytren’s fasciectomy reduces a lot of problems associated with Dupuytren’s contracture still you will not be able to put your hand flat on the table even after the surgery.
How is Dupuytren’s Fasciectomy Done?
In Dupuytren’s fasciectomy, the surgeon removes or divides the thickened tissue from the palm. The surgeon gives general anesthesia to the patient before performing Dupuytren’s fasciectomy to prevent the pain. Then the surgeon makes an incision in the hand and removes the affected connective tissue. Once the affected thickened tissue is removed, the surgeon grafts the skin for sealing the wound.
Generally, three kinds of process are involved in Dupuytren’s fasciectomy such as:
- Segmental: In this process of Dupuytren’s fasciectomy the surgeon makes one or more small incision and removes the short segment of the cord.
- Regional: In this process of Dupuytren’s fasciectomy the surgeon makes one long incision and removes the entire cord.
- Dermo Fasciectomy: In this process of Dupuytren’s fasciectomy the surgeon removes the cord as well as the overlying skin and it needs a skin graft as well.
What Complication May Occur After Dupuytren’s Fasciectomy and How Long To Recover From It?
Certain complications may occur after the surgery of Dupuytren’s contracture and these may include the following:
- Wounds or injury to the blood vessel and nerve
- Loss of sensation
- Loss of viability in finger
It can take some time to recover from the above complications especially if the Dupuytren’s fasciectomy surgery is extensive. Physiotherapy that includes massage, manipulation or exercise helps in a great way to get rid of the complication. Sometimes the doctor may recommend wearing hand splint during the initial period.(2)
Dupuytren’s fasciectomy is not a very complicated surgery and generally, the patient is released on the same day. However, in some case, the doctor may advise staying for a night in the hospital after the surgery. Generally, the surgery does not cause too much problem but sometimes you may observe some pain, stiffness, and swelling. However, even after Dupuytren’s fasciectomy, doctors recommend going for physical therapy that can help in improving the strength and functioning of finger and hand. Though in most cases patient gets improvement after Dupuytren’s fasciectomy the condition of Dupuytren’s contracture is found to reoccur in 20% of patient.