What is Dupuytren’s Fasciectomy?
Dupuytren’s disease is actually a condition in which the fibrous tissue, known as fascia, of the hand gets affected. Fascia lies underneath the skin in the palm and finger and due to Dupuytren’s disease fascia thickens and tightens over time. Due to this condition, it seems that the fingers will be pulled inward towards the palm and the condition is called Dupuytren’s contracture. In some cases, it is found that Dupuytren’s contracture causes a problem in performing daily activities. During such 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 skin1. Due to this condition, it becomes problematic to straighten or spread the finger and thumb.
How to Decide for Dupuytren’s Fasciectomy?
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 doctors may recommend non-surgical treatment to prevent it from worsening. 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. Unfortunately, it 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 Dupuytren’s fasciectomy. The most common indication for surgery is a 40-degree contracture at the metacarpophalangeal joint and a 20 degree contracture at the proximal interphalangeal joint2. Currently, there is no cure of Dupuytren’s contracture but with Dupuytren’s fasciectomy, it is only possible to reduce the progression of 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 one faces due to Dupuytren’s contracture. Although Dupuytren’s fasciectomy reduces a lot of problems associated with Dupuytren’s contracture, one might still not be able to put your hand flat on the table even after the surgery.
How Dupuytren’s Fasciectomy is Done?
In Dupuytren’s fasciectomy, the surgeon removes or divides the thickened tissue from the palm. General anesthesia is given to the patient before performing Dupuytren’s fasciectomy. The surgeon then 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 Dupuytren’s Fasciectomy: In this process of Dupuytren’s fasciectomy, the surgeon makes one or more small incision and removes a short segment of the cord that has thickened.
Regional Dupuytren’s Fasciectomy: 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 To Recover From It?
Certain complications may occur after Dupuytren’s fasciectomy and these may include the following3:
- Wounds or injury to the blood vessel and nerve
- Loss of sensation
- Loss of viability in finger.
It can take some time to recover 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 complication1 Dupuytren’s fasciectomy. Sometimes the doctor may recommend wearing hand splint during the initial period.
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. 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 improves after Dupuytren’s fasciectomy, the condition of Dupuytren’s contracture is found to reoccur in 20% of patient.