Name of the Procedure:

Fasciotomy, Palmar (e.g., Dupuytren's Contracture); Percutaneous

Summary

A percutaneous palmar fasciotomy is a minimally invasive surgical procedure designed to relieve tension in the palmar fascia. It's commonly used to correct Dupuytren's contracture, a condition where the fingers become permanently bent in a flexed position.

Purpose

Medical Condition: Dupuytren's contracture. Goals: To release contracted fascia, straighten the fingers, and restore hand functionality.

Indications

• Presence of Dupuytren's contracture.
• Noticeable finger flexion that affects hand function.
• Failed non-surgical treatments (e.g., physical therapy).
• Patients with significant functional impairment or discomfort.

Preparation

• No need for fasting generally required.
• Adjustments or temporary discontinuation of certain medications, as advised by the physician.
• Preoperative assessment including imaging and blood tests.

Procedure Description

1. Local anesthesia is administered to numb the hand.
2. A series of small incisions or needle punctures are made in the palm over the affected fascia.
3. Special instruments are inserted percutaneously to cut the tight bands of fascia.
4. The surgeon carefully releases the contracted tissue, allowing the fingers to straighten.

Tools and Equipment: Needles, specialized cutting instruments, local anesthetics.

Duration

Typically takes around 30 to 60 minutes.

Setting

Performed in an outpatient clinic, surgical center, or hospital outpatient department.

Personnel

• Orthopedic or plastic surgeon specialized in hand surgery.
• Nursing staff to assist and support during the procedure.
• An anesthesiologist or nurse anesthetist if sedation is necessary.

Risks and Complications

Common Risks:

• Infection at the incision site.
• Pain or tenderness in the affected hand.

Rare Complications:

• Nerve or vascular injury.
• Incomplete release of the contracture.
• Recurrence of Dupuytren's contracture.

Management of complications generally involves medical treatments or, rarely, further surgical intervention.

Benefits

• Significant improvement in hand function.
• Relief from discomfort and pain caused by the contracture.
• Typically, a quick recovery with minimal downtime.

Recovery

• Post-procedure instructions include keeping the hand elevated and avoiding heavy use.
• Possible use of a splint or physical therapy to maintain finger flexibility.
• Most patients resume normal activities within a week.
• Follow-up appointments to monitor healing and functionality.

Alternatives

• Non-Surgical: Physical therapy, splinting, collagenase injections.

• Surgical: Open fasciotomy or fasciectomy.

  Pros and Cons:

• Non-surgical methods are less invasive but may be less effective for severe cases.
• Open surgeries may offer more permanent correction but involve greater risks and longer recovery times compared to the percutaneous procedure.

Patient Experience

During the procedure, the patient will feel minimal pain due to local anesthesia. Post-procedural discomfort can be managed with prescribed pain medications and proper care. Most patients experience a rapid return to daily activities with improved hand function.