Background

Background:

Fasciectomy is a surgical procedure that removes fascia, the connective tissue beneath the skin.

Treatment addresses thickened and contracted fascia conditions effectively.

Fasciectomy removes tight fibrous tissue in the hand surgically.

Dupuytren’s contracture is the most common reason for this surgical procedure.

Dupuytren’s disease causes nodules to form on the fascia beneath the skin of the palm.

Before surgery, Dupuytren’s contracture was treated with splinting and stretching.

Types of Fasciectomy are:

Limited Fasciectomy

Subtotal or Selective Fasciectomy

Radical Fasciectomy

Dermofasciectomy

Indications

Fasciectomy restores hand function in fingers and thumb. Removal of fascia enables stretching and straightening digits.

Dupuytren’s Contracture

Ledderhose Disease

Peyronie’s Disease

Fibromatosis

Contraindications

Poor General Health or Medical Fitness

Advanced Age or Frailty

Active Infection

Severe Peripheral Neuropathy or Nerve Involvement

Extensive or Diffuse Disease

Inadequate Skin or Soft Tissue Coverage

Malignancy

Outcomes

Fasciectomy for Dupuytren’s contracture often leads to improved hand function and reduced deformity.

Patients see notable gains in hand mobility and grip strength with mild to moderate contractures.

Recovery after surgery is slower due to weight-bearing needs, but patients gain pain relief and improved mobility.

Fasciectomy aims to decrease curvature and enhance sexual function.

Success rates for curvature improvement are high with 70%–80% of patients reporting positive outcomes.

Equipment required

Surgical Equipment

Cutting & Dissection Instruments

Tissue Forceps & Retractors

Hemostasis & Cautery

Nerve & Vessel Protection

Closure & Dressing Materials

Patient Preparation

Patient Assessment including medical history, physical examination, laboratory tests, and imaging.

Segmental fasciectomy is an outpatient procedure for same-day discharge.

Regional anaesthesia may numb your upper body, and the surgeon might leave the small wound open.

Early mobilization and gentle exercises are recommended post-hand fasciectomy to prevent stiffness.

Informed Consent:

Explain the procedure’s risks and potential complications clearly to the patient.

Patient Positioning

Patient positioning is crucial for optimal surgical access and reduces risks of pressure sores and nerve injury.

Technique

Step 1: Anesthesia

The procedure is performed under general anesthesia.

Step 2: Incision

A curved incision is made over the affected palm. The incision is placed to minimize visible scarring.

Step 3: Exposure

The skin is carefully retracted to expose the underlying palmar fascia.

Surgeons utilize blunt and sharp dissection to access contracted fascia with minimal damage.

Step 4: Fascia Removal

The thickened and diseased fascia is identified and exercised by surgeons.

Step 5: Wound Closure

Wound closed with dissolvable or non-dissolvable sutures post-removal.

Step 6: Splinting

Dynamic splint immobilizes hand to preserve finger extension during healing.

Fasciectomy

Complications

Bleeding and Hematoma Formation

Infection

Nerve Injury

Vascular Injury

Wound Dehiscence

Recurrence of Disease

Joint Stiffness and Loss of Range of Motion

Hypertrophic Scarring

Complex Regional Pain Syndrome

References

Dupuytren’s Fasciectomy: Surgical Pearls in Planning and Dissection – PMC

References

Dupuytren’s Fasciectomy: Surgical Pearls in Planning and Dissection – PMC