Dupuytren’s Contracture or Fasciectomy

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Dupuytren’s Contracture: aka partial fasciectomy, fasciectomy, Morbus Dupuytren 

 

 

 

What is it?
This occurs when the layer of tissue that is found just under the skin on the palm of a patient’s hand becomes abnormal.  This is known as the fascia, and it forms a band that is thicker than it normally is and shortened.  This band will prevent a patient from being able to straighten his or her finger.  This condition is known as  Dupuytren’s contracture.  It’s a condition that is common in adult patients.  Most of the times when someone develops it, it happens for no apparent reason.  But it’s found to happen more frequently among alcoholics, heavy smokers, diabetics, and older men.  It’s also found in people who suffer from epilepsy that were treated with medications that are known as phenytoins.  It’s also a possibly hereditary condition.

 

 

 

 

The Operation

 

The surgery that is used to correct the fascia and the skin in a patient’s palm is known as a palmer fasciectomy.  This is sometimes done under local anesthetic or general anesthetic.

The surgeon will make a cut in the patient’s palm and a cut which zigzags up the patient’s finger.  The abnormal band of skin in the palm will be removed and the normal skin of the patient’s palm will be left behind.

 

The wound on the patient’s skin will be closed with stitches, and sometimes there will be a fine tube for drainage made of plastic which leads out of the wound. 

 

The surgery is either done as an outpatient or inpatient, depending on the patient and the surgeon.  When it’s done as an outpatient, the patient is sent home the same day once they have recovered.  For an inpatient procedure, they may have to stay overnight.

If the patient is given a local anesthetic, he or she will be awake during the surgery, but may be drowsy from a sedative.  If the patient is given a general anesthetic, they will sleep through the surgery. 
 

If the patient has a knuckle joint that is bent due to the contracture, the surgeon will usually be able to straighten it.  If it’s the patient’s finger joint that is bent, he may not be able to straighten it completely, but it will be less bent than it was before.

 

 

 

Alternatives to Surgery
 

 

There aren’t a lot of alternatives to the surgery.  If the patient can lay their hand completely flat on a table, a surgery is not recommended.   Just because a patient may have a band, it doesn’t mean that surgery is required.  When the patient gets to the point where they are unable to straighten a finger completely, they should look into the surgery.  Things such as injections and exercises to stretch the muscles and tendons don’t help.

 

Before the Operation
Before a patient has this surgery, they should have a physical to see how their health is.  If they are overweight, they should try and lose some weight.  If they smoke, they need stop smoking.  If the patient has problems with their heart, lungs, or blood pressure, the patient’s family doctor should check them to see if they are under control.

 

 

The patient should try and refrain from drinking alcohol when it’s a week before their surgery, because that can thin their blood and cause excess bleeding.

If the patient is taking the contraceptive pill or  medication for hormone replacement therapy, the patient should find out what their policy and advice is about taking them before surgery. 

On the day of the surgery, the patient should bring a friend or relative with them to take them home after surgery and to help them out after their surgery.  The patient should also take their medications with them to the hospital.

 

 

 

After the Surgery - In the hospital
The patient will wake up to find that there is a bulky bandage wrapped around their hand.  The arm that was operated on will be elevated either on a a pillow or will be wrapped in a roller towel, preventing the hand from swelling too much.  The patient may feel some pain, but that can be controlled with medications through tablets or injections.  The patient should feel free to ask for more if the pain increases.  The patient may need to put their arm in a sling and the patient will not feel like his or herself until the affects of the anesthesia wear off. 

 

 

 

 

After the surgery - At home

 

The surgeon will let the patient know what they can and can’t do, and when.  The patient will be instructed on how they should care for their hand and when the dressing can be removed. The patient may be given exercises and different things to do to help with the healing of their hand.

 

The patient may have post operative checkups to see how their hand is healing and how they are doing overall.

 

General Advice
When a patient has this condition, there aren’t a lot of things that they can do to help it other than have the surgery. The condition will worsen with time and most patients that have the condition will end up having the surgery eventually. If the patient thinks that they have this problem, they should talk to their doctor and see what the doctor suggests.

 

It’s a surgery that isn’t very difficult and it can help to make a person’s hand to feel better.  When the patient has fingers that are crooked, they may be the perfect candidate for the surgery.

 

 

 

Estimated Costs for Fasciectomy Surgery

 

Country Costs  Fasciectomy
USA $4,100-5,000
India $2,000-3,300
Malaysia $2,800-3,500
Singapore $3,000-4,500
Thailand $2,500-3,500

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