or nerve injury, infection, and hematoma (pocket of blood) formation.
This procedure has replaced the “open fasciotomy” in many practices.
Palmar Fascia Removal (partial or limited palmar fasciectomy)
This remains the gold standard of treatment for Dupuytren's contracture. Removal of the diseased palmar fascia causing the contracture will usually give a very good result. Final outcomes depend a great deal on the success of doing the postoperative physical or occupational therapy as prescribed. If you decide to have this surgery, you must commit to doing the therapy needed to make your surgery as successful as possible.
Removal of the entire palmar fascia (radical fasciectomy) requires extensive removal of involved and non-involved palmar and digital (finger) fascia. This procedure may be required in cases of severe or recurrent Dupuytren's contracture. This approach has higher complications rates without providing better success rates so it is not done as often anymore.
Complications of a palmar fasciectomy can include permanent nerve damage, joint pain and stiffness, hematoma (pocket of blood), infections, and poor wound healing.
Surgery does not always fully restore range-of-motion and function but it usually increases the ability to extend (straighten) the affected fingers. You should also be aware that the problem can come back and/or spread. In other words, surgery is not always “curative.”
A skin graft may be needed if more extensive removal of the palmar fascia is required. This may be the case when the skin surface has contracted so much that the finger cannot relax as it should and the palm cannot be stretched out flat. Surgeons graft skin from the wrist, elbow, or groin. The skin is grafted into the area near the incision to give the finger extra mobility for movement.
Related Document: A Patient's Guide to Dupuytren's Contracture Surgery
What should I expect after treatment?
No formal physical therapy is generally needed for enzyme fasciotomy.
After a needle aponeurotomy usually physical therapy is not required. Patients are advised to keep their hand iced and elevated for two days following the procedure. NO strenuous gripping for one week. After one week, return to activities as tolerated. Occasionally a splint is prescribed for night use.
After a partial palmar fasciectomy, your hand will be bandaged with a well-padded dressing and a splint for support after surgery. Palmar wounds from the incisions take about three to five weeks to heal.
Physical or occupational therapy sessions will be needed after surgery for up to six weeks. Visits will include heat treatments, soft tissue massage, and vigorous stretching. Therapy treatments after surgery can make the difference in a successful result after surgery.
Studies show that patients with more severe disease (especially affecting the proximal interphalangeal (PIP) joints) have a higher risk of disease recurrence. In fact, for all treatment approaches (surgical and nonsurgical), the metacarpophalangeal (MCP) joints are easier to treat with better outcomes and fewer cases of recurrence.
As many as half of all patients who have surgery report return of flexion contractures within five years of surgery. Patients with PIP contractures seem to have the highest recurrence rates.