Name of the Procedure:

Fasciotomy, palmar; open, partial (commonly referred to as surgery for Dupuytren's contracture)

Summary

A fasciotomy is a surgical procedure that involves cutting the fascia, a fibrous tissue under the skin, to relieve tension. This particular surgery is performed on the palm of the hand to treat Dupuytren's contracture, a condition where the tissue thickens and tightens, causing the fingers to bend inward. The open, partial method involves making an incision to partially cut the affected fascia.

Purpose

The procedure addresses Dupuytren's contracture, a condition that restricts finger movement due to thickened tissue in the hand. The goal is to release the tightened fascia, thereby improving hand function and reducing the contracture of the fingers.

Indications

• Presence of nodules or thickened tissue in the palm.
• Difficulty extending fingers fully.
• Progressive bending of the fingers towards the palm.
• Functional impairment impacting daily activities.

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Medication adjustments, especially blood thinners, as advised by the healthcare provider.
• Pre-surgical assessments including blood tests, imaging studies, and a detailed medical history review.

Procedure Description

1. The patient is given regional or general anesthesia to numb the hand or induce sleep.
2. An incision is made in the palm over the affected area.
3. The surgeon carefully identifies and cuts through the thickened fascia, partially releasing it.
4. Care is taken to avoid damage to nearby nerves and tendons.
5. The incision is then closed with sutures and dressed.

Tools and Equipment:

• Scalpel
• Surgical scissors
• Retractors
• Sutures

Duration

The procedure typically takes around 1 to 2 hours, depending on the severity of the contracture and the individual case.

Setting

The procedure is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding
• Nerve or tendon injury
• Recurrence of the contracture
• Scarring and stiffness in the hand
• Pain and swelling post-surgery

Benefits

• Improved finger extension and hand function
• Relief from pain and discomfort caused by the contracture
• Increased ability to perform daily activities
• Benefits typically realized within weeks to months post-surgery

Recovery

• Post-procedure care includes keeping the hand elevated, managing pain with prescribed medications, and attending follow-up appointments.
• Physical therapy may be recommended to regain strength and motion.
• Stitches are usually removed after 10-14 days.
• Full recovery can take several weeks to a few months, with activity restrictions gradually lifted.

Alternatives

• Non-surgical options like needle aponeurotomy, enzyme injections, and physical therapy.
• Pros and cons vary: non-surgical methods may be less invasive with quicker recovery but might not be as effective long-term compared to open fasciotomy.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-surgery, there may be discomfort, swelling, and need for pain management. Following the care instructions and attending therapy sessions can aid in a smoother and quicker recovery.