Dupuytren's fasciectomy: How effective is it?

Dupuytren’s contracture is a hand condition where the connective tissue beneath the skin of the palm thickens and tightens, forming cords that can bend one or more fingers into a fixed position. While the condition often starts mildly, it can progress, limiting hand function and 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. 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 tissue that cause finger contraction are carefully removed. Depending on the severity, fasciectomy can be performed in one of two ways:

• Partial fasciectomy: Only a portion of the thickened tissue is removed, targeting the most affected areas. This is the most common approach and aims to relieve contracture while preserving function.
• Total fasciectomy: In more severe cases, a larger section of tissue may need to be removed. However, this approach is less common due to the higher risks of complications.

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. Studies indicate that up to 80 to 90 per cent of patients achieve notable symptom relief after the procedure. However, the degree of effectiveness can vary based on individual factors, such as:

• Stage of the disease: Early intervention often leads to better outcomes, as less tissue has been affected.
• Severity of the contracture: Advanced cases may require more extensive surgery, which could affect the range of motion post-surgery.
• Patient age and health: Younger patients or those without other health issues may recover more fully and quickly than older patients or those with underlying health issues.

How long do results typically last?

While fasciectomy provides substantial improvement in the short to medium term, Dupuytren’s contracture has a tendency to recur, as it is a progressive condition. For many patients, the results of a fasciectomy can last several years, and some may enjoy long-term symptom relief. However, studies suggest that around 20 to 30 per cent of patients experience recurrence within five years of surgery. Recurrence rates are slightly lower for more advanced procedures like total fasciectomy but may come with higher risks of complications.

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, though recurrence rates are lower than with less invasive treatments, such as needle aponeurotomy.

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.
• Collagenase injections: Collagenase injections can soften the tissue cords, allowing the finger to be manually straightened. This approach is less invasive and generally well-tolerated, though it may not be as effective for more severe cases.
• Radiotherapy: In very early stages, radiotherapy can slow the progression of Dupuytren’s contracture. This approach is less common and usually reserved for cases where contracture has not yet significantly progressed.

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 progressive 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.