Surgical fasciectomy for Dupuytren’s contracture

Abstract

Dupuytren’s contracture is a fibroproliferative disorder causing cosmetic and functional deficits of the hands. Surgical intervention is typically recommended when the contractures of the metacarpophalangeal and proximal interphalangeal joints reach 30° and 15-20°, respectively. Collagenase injections and percutaneous fasciotomy have a role in the treatment of select patients and are discussed elsewhere in this textbook. At present, partial fasciectomy remains the gold standard treatment option, particularly for severe, extensive, or recurrent contractures. Open fasciotomy, segmental aponeurectomy, and radical fasciectomy are less commonly utilized. Dermatofasciectomy is useful in cases of severe contractures or recurrence, especially when the disease has become intimately involved in the overlying skin. Alternatively, the open palm technique is a well-established and successful treatment option in cases of contracture correction with resulting skin deficit. The open wound heals by secondary intention. Surgical fasciectomy is typically a well-tolerated outpatient procedure with low risk of serious complication. Operative management focuses on resection of diseased tissue only and careful protection of neurovascular structures. Patients must be counseled on the risk of recurrence and/or extension, which varies from 8 to 54%. Early-onset disease and ectopic foci increase this risk further. Postoperative management focuses on wound healing and early motion exercises.