Dupuytren's fasciectomy: How effective is it?
Written in association with:Dupuytren's disease is a condition where the connective tissue beneath the skin of the palm, called palmar fascia, thickens. It initially forms lumps called nodules which join together to form bands called cords, which then grip the skin and pull one or more fingers into a fixed position called contractures. This can limit hand function and affect quality of life.
A fasciectomy, or surgical removal of the affected tissue, is one of the primary treatments for more advanced cases of Dupuytren’s contracture. The article explores the effectiveness of fasciectomy, potential benefits and factors influencing outcomes.
What is a Dupuytren’s fasciectomy?
A Dupuytren’s fasciectomy is a surgical procedure in which the thickened cords of scar tissue that cause finger contraction are carefully removed. This can range from simply cutting the fibrous band, to removing the tissue and the affected skin and replacing the skin with skin graft called a dermofasciectomy.
How effective is Dupuytren’s fasciectomy?
A fasciectomy is generally effective in restoring finger movement and improving hand function. Success rates are typically high, with most patients experiencing significant improvement in finger extension, allowing them to open their hand more fully.
If the deformity in the finger is severe and has been present for a long time especially in the middle joint of the finger, a full correction is sometimes not possible.
Surgeons will discuss on an individual basis the other issues which are associated with the surgery like scarring and the rehabilitation involved.
A hand therapist forms a crucial part of the team to help patients achieve the full benefits of the procedure.
How long do results typically last?
For many patients, the results of a fasciectomy can last several years, and some may enjoy long-term symptom relief.
While fasciectomy provides substantial improvement, Dupuytren’s contracture has a tendency to recur.
There are various theories as to why Dupuytren's disease occurs and the one theory which has the most evidence is that it's a genetic disease.
Hence surgeons can remove the effects of the disease that is the contracture, but not the cause.
Not all recurrences need re-operations as sometimes they may not be severe, but in some cases, re-operations may be needed.
What are the benefits of Dupuytren’s fasciectomy?
The primary benefits of fasciectomy are:
- Improved hand function: Restoring the ability to open the hand and straighten affected fingers helps improve daily function and quality of life.
- Enhanced range of motion: Patients often regain flexibility, enabling them to perform tasks that were challenging or impossible before surgery.
- Relief from discomfort: Some patients find the thickened cords uncomfortable or painful, and fasciectomy can relieve this discomfort.
What are the potential risks and complications?
While Dupuytren’s fasciectomy is generally safe and effective, it comes with certain risks:
- Infection: Like any surgical procedure, there’s a risk of infection, although this is relatively low.
- Nerve or blood vessel injury: Due to the complex anatomy of the hand, there is a small risk of damage to surrounding nerves or blood vessels.
- Stiffness or scarring: Some patients may experience stiffness or excessive scar tissue, which could limit range of motion.
- Recurrence: Dupuytren’s contracture can return over time.
Are there alternatives to fasciectomy?
Several alternative treatments are available, especially for mild to moderate cases:
- Needle aponeurotomy: This minimally invasive technique involves inserting a needle to break up the cords of tissue. While effective for mild cases, recurrence rates are higher than with fasciectomy.
- Dermofasciectomy: For very severe cases,the skin over the contracture needs to be excised and replaced with a skin graft typically from the arm.
- Radiotherapy: There's limited evidence to support its routine use and it is suitable only in some very select patients with very early onset of disease.
Dupuytren’s fasciectomy is an effective treatment for advanced cases of Dupuytren’s contracture, with high success rates and substantial improvements in hand function. However, while the procedure provides long-lasting relief for many, recurrence is possible, especially as Dupuytren’s is a genetic condition. For patients with mild cases, less invasive treatments may offer short-term relief, but for more significant contractures, fasciectomy remains the gold standard, helping patients regain hand function and improve quality of life.
