Limited Palmar Fasciectomy Dupuytren's Contracture
This surgical procedure is performed to treat fingers that have become flexed because of Dupuytren's contracture. In this procedure, the thickened and contracted part of the fascia - the layer of tissue just beneath the skin - is removed. There are many variations of this surgery based on the severity of the condition.
Dupuytren's contracture is a rare hand disorder caused by a thickening of the layer of fibrous tissue beneath the skin of the palm and the fingers. This thickening causes tendons to tighten (contract), which makes the finger difficult to extend. As a result, the finger is continually "curled up." Dupuytren's contracture is more common in men than women and is more likely to occur in patients who drink significant amounts of alcohol, have diabetes, smoke or have certain types of seizures.
Limited palmar fasciectomy is a surgical procedure used to treat the fingers that have been affected by Dupuytren's contracture. During this procedure, the thickened part of the fascia, which is the layer of tissue just below the skin, is removed to restore movement and flexibility to the fingers.
Causes of Dupuytren's Contracture
While the exact cause of Dupuytren's contracture is unknown, various factors may contribute to the condition. Dupuytren's contracture is most frequently found in people of Northern European (English, Irish or French) or Scandinavian (Danish, Swedish or Norwegian) descent. Other possible contributing factors include:
- Family history of the condition
- Preexisting medical conditions including diabetes and seizures
- Age, as the condition usually appears in those over 40
- Gender, as males are more likely to develop the condition
- Heavy consumption of alcohol
Symptoms of Dupuytren's Contracture
The symptoms of Dupuytren's contracture usually develop gradually. Symptoms may include one or more small nodules that form in the palm. Although tender when they first form, the tenderness often disappears. Nodules can then thicken and contract, forming tough bands of tissue beneath the skin. Eventually, one or more of the fingers may curl toward the palm. Over time, straightening the curled fingers may be difficult, affecting the ability to grasp large objects. Although all fingers can be affected, the two most common are the ring and "pinky" fingers.
Candidates for Limited Palmar Fasciectomy for Dupuytren's Contracture
For patients whose symptoms of Dupuytren's contracture cause no pain, treatment may not be needed. If the condition continues to progress and causes pain, nonsurgical treatments may be used to dissolve the cords that are pulling the fingers toward the palm. These treatments include using a needle to break apart the cord of tissue contracting the fingers, or injections of steroids to help relieve pain. If the Dupuytren's contracture symptoms worsen, surgery may be recommended. Limited palmar fasciectomy is normally reserved for more severe forms of the condition.
The Limited Palmar Fasciectomy Procedure
The main purpose of the limited palmar fasciectomy is to remove the thickened part of the fascia tissue beneath the skin. This can successfully restore the range of motion to fingers that have become curled because of Dupuytren's contracture. During the procedure, the patient will be positioned so that the palm of the hand is visible and accessible to the surgeon.
Limited palmar fasciectomy is performed as an outpatient procedure, under general anesthesia. Several incisions will be made to access the fascia of the palm, as well as the fingers that have been impacted by the condition. The thickened cords of the fascia are carefully removed, allowing the fingers to extend more normally. In some severe cases, all underlying tissue affected by Dupuytren's contracture will require removal, including the attached skin. In such cases, a skin graft is used to cover the resulting wound. Once the procedure is complete, the incision is closed with sutures.
Risks of Limited Palmar Fasciectomy
Complications after a limited palmar fasciectomy are more likely to occur in patients who have a pre-existing medical condition. Possible complications associated with this procedure include:
- Failure of the skin graft
- Postoperative pain
- Joint stiffness
- Recurrence of Dupuytren's contracture symptoms
- Discoloration of the skin
Results of Limited Palmar Fasciectomy
After the procedure, a bandage and splint will be applied to provide support to the operative fingers. Limited palmar fasciectomy is considered the most invasive form of treatment for Dupuytren's contracture, and as a result, has the longest recovery time. Following this surgery, patients will usually require several months of intensive physical therapy. Physical therapy programs usually focus on exercises and movements designed to restore full function to the fingers and hand.