What is palmar fasciectomy for Dupuytren's contracture?
Dupuytren's contracture is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended (straightened).
The usual operation for Dupuytren’s contracture is called palmar fasciectomy. It involves removal of a section of the tissue (the fascia) under the skin on the palm of the hand. The operation is either performed as a day-case, or will involve one night’s stay in hospital.
Palmar fasciectomy may be done under general anaesthesia, which means you will be asleep throughout the procedure. But it can also be done under regional anaesthesia, which means that you will still be awake but your hand will be numb.
Your surgeon will explain the benefits of having the surgery, and discuss the associated risks and alternatives to the operation.
About the palmar fasciectomy operation
Once the anaesthetic has taken effect, a tourniquet is put around the upper arm to control bleeding during the operation. Incisions are made into the affected fingers and palm. The affected tissue is removed, and the fingers are allowed to relax into their normal position.
In most cases, the cuts are stitched together to create a zig-zag scar that heals to allow the fingers to move freely. Sometimes stitches are not used because some surgical incisions heal better without them, causing less scarring and discomfort.
If the skin is also affected by Dupuytren’s disease, some of it may need to be removed. If this happens, a skin graft may be necessary. Skin will be taken from another part of the body to replace skin on your hand. This is a more complicated operation known as dermofasciectomy.
Local anaesthesia is usually injected around the operation site so that your palm and fingers are numb and you will not be in pain immediately after the operation. The operation may take an hour or more, depending on how many fingers are involved.
Once the local anaesthesia wears off, it is likely that you will have some pain or discomfort for a few days. Also, your hand will probably be swollen and bruised. This should settle down in two to three weeks.
The scar may be tender for a couple of months and the surrounding skin may become very dry. This can usually be relieved with a moisturiser such as E45. Ask your surgeon or nurse for advice.
A palmar fasciectomy is a commonly performed and generally safe operation. However, all surgery carries an element of risk.
Though surgery can help to improve the flexibility in your fingers, it does not stop the process of Dupuytren’s disease. So the contracture may return, requiring another operation.
Some other complications specific to palmar fasciectomy are shown below.
- In a few people the hand becomes stiff and painful. This is usually treated with physiotherapy.
- In severe cases, it may not be possible to fully straighten the fingers. Splints may be used afterwards to improve the results.
- The nerves to the fingers may be damaged, causing numbness in part of the finger. This is more likely to happen when a repeat fasciectomy is done. It may be possible to repair the damage with further surgery.
- Skin grafts may not “take” successfully in some cases.
- Very rarely, a finger may be lost. If you have had lots of previous hand surgery, have a disease that affects your circulation such as diabetes, or are a heavy smoker, this risk will be higher.
The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain how any risks apply to you.
Why should I consider having a palmar fasciectomy for Dupuytren's contracture at a Spire hospital?
Whether you have medical insurance or are paying for your treatment yourself, with Spire Healthcare you will be seen quickly by the consultant-grade doctor of your choice at a time that suits you. You will be treated in a premium private hospital with some of the UK's highest standards of cleanliness and infection control.
To find out more about having a palmar fasciectomy privately or to get a guide price, simply