Excision of a Dupuytren's Contracture
Local fasciectomy, the removal of abnormal fascia only, is the treatment of choice and is described here. Radical fasciectomy, involving the removal of both normal and abnormal fascia gives swelling, stiffness and poor results. Subcutaneous fasciotomy has few indications.
General, local or regional.
The hand is placed on an arm board. A malleable metal hand is useful to stabilise the fingers. A tourniquet is applied to render the operative field bloodless.
Many are described and all must confirm to the principles of siting scars in the hand. Examples are the zig-zag and longitudinal Z-plasty incisions made along the volar surface, over the abnormal fascia.
The resultant skin flaps are raised to adequately expose the cords of abnormal tissue.
Skin flaps should be as thick as possible and careful scalpel dissection allows identification of the digital nerves. These must be separated from the abnormal palmar fascia to preserve finger sensation.
The abnormal fascia is excised.
The skin is closed with fine nylon sutures. The transverse palmar incision may be left open and heals well by secondary intention. The hand is dressed in the position of function with a boxing glove dressing.
- Elevate the hand immediately after surgery.
- Active hand physiotherapy is begun after a few days.
- Night splints are worn for some weeks to keep the MCP and IP joints extended.
Main Postoperative Complications
Include skin flap necrosis, digital nerve damage. Later on, recurrence or, more likely, extension