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Palmar Fasciectomy

Palmar fasciectomy is a surgical procedure to correct Dupuytren's disease (Dupuytren’s contracture, morbus Dupuytren, "Viking disease", or "Celtic hand"), a progressive condition where the fingers bend toward the palm at the first or second joint and cannot be fully extended (straightened). Dupuytren's disease is a hereditary condition that causes the abnormal formation of cords and knots in the connective tissue fibers, or fascia, that hold the palm skin in place. These reduce the ability to straighten fingers and use the hand normally. The ring finger and little finger are the fingers most often affected.

Despite clinical trials evaluating the effectiveness of collagenase injections, surgical removal of the abnormal fascia tissue via one or more incisions is the most widely accepted treatment for Dupuytren’s disease (release but not removal of the fascia cords, called palmar fasciotomy, is less commonly prescribed). The use of surgery is determined by the patient and surgeon based on the level of disfunction caused by the condition. Sometimes surgery targets only the most affected fingers, and sometimes all affected fingers.

Palmar fasciectomy can be open (requiring an incision) or percutaneous (a small needle is inserted multiple times into the cord). In both types, the arteries and nerves going to the fingers are protected to prevent injury. The operation can be done under general anesthetic or a regional/local anesthetic (patient remains awake), and is normally done on an outpatient basis, taking from one to several hours depending on the number of fingers involved and the contractures’ severity. Recovery and therapy (sometimes with the use of splints) can continue for 6 weeks up to 3 months. Success in restored hand function depends on which joints are affected, the severity of the deformity and how long the deformity has been present. The procedure does not cure the disease; it is only able to modify disease progression and improve hand function by removing diseased tissue. Recurrence is common after any procedure.

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Palmar fasciectomy