Limited Palmar Fasciectomy for Dupuytrens Contracture

Dupuytren’s Contracture (also known as palmar fibromatosis) is a deformity that can develop in the hands and fingers, usually over the course of several years. Inside the hand, there is a layer of connective tissue known as the palmar fascia. Dupuytren’s contracture occurs when the palmar fascia contracts and thickens, pulling one or more fingers into a curled position towards the palm. This can be very frustrating and limiting, though it is usually not painful. This can be treated through a palmar fasciectomy, which is a surgery that can help the fingers extend back into a normal, upright position. 

Why would someone need limited palmar fasciectomy?

As dupuytren’s contracture develops, generally the pinky finger is the first one affected. This can continue to the other fingers as well. Very rarely is the thumb affected, and in most cases the index finger is only slightly affected. Even with the use of the index finger and thumb, this reduction of motion can make even the simplest things difficult, as most people use their hands constantly every day. As the contracture develops, some people begin to see lumps or dimples on their palms as the fascia bunches up and knots together. There is no evidence that there is a cause to dupuytren’s contracture, as it seems to be possibly genetic or hereditary. 

Basics of Limited Palmar Fasciectomy

This surgery can vary greatly because of the nature of dupuytren’s contracture, but also because hand surgery processes varies as well. This can involve multiple fingers at different stages of contracting. Most operations begin with the patient receiving general anesthesia, then also numbing or pain blocking the palm and fingers of the affected hand. The hand is then sterilized and positioned with the palm facing upward. This surgery is complicated because although the incisions may not be as deep, usually a large incision is made and the various nerves and muscles are exposed for the duration of the surgery. The nerves and muscles are protected as much as possible, but the fascia is very close to many important parts of the inner hand. Once the fascia has been exposed and identified, the surgeon then cuts away the thickened and knotted portions, allowing the fingers to extend. In some cases, this is only a small amount, and the skin can then be normally closed with stitches. In other operations, the skin may have become warped over time, and a skin graft may be applied to help the fingers extend more normally. Sometimes, the incision may be left open so that the area can properly drain, but in most cases a small drain made of medical grade plastic is placed under the skin, so any excess fluid can leach out of the wound. 

Recovery and Healing of Palmar Fasciectomy

Most patients can return home directly after the surgery is completed. Most patients experience swelling and pain in the hand for the first few weeks. Some patients can experience numbness or tingling as a result of slightly damaged or compressed nerves. This should go away as the healing progresses. If placed, the drain is removed after a few days, and stitches are removed about 10-14 days after the surgery. Physical therapy is always required after a palmar fasciectomy to ensure that the hand can regain motor skills and stretch the tendons and skin. This will continue as the doctor recommends, and can last up to about 6 months or longer. 

Long Term Effects 

Most patients experience an enormous difference in their ability to move and grasp with their fingers after recovering from the fasciectomy. Unfortunately, some patients do experience a relapse of symptoms where the remaining fascia continues to thicken and restrict the fingers. Although this may occur, most people do not experience nearly the same level of restriction or discomfort as before. This surgery is generally considered a long term solution to a difficult and complicated problem.