26121 Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)

Name of the Procedure:

Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting

Summary

A fasciectomy is a surgical procedure to remove diseased fascia (connective tissue) from the palm. This procedure may include Z-plasty, other local tissue rearrangements, or skin grafting to improve hand function and appearance.

Purpose

Fasciectomy aims to treat Dupuytren's contracture, a condition where the fascia in the palm becomes thickened and contracted. This condition can cause fingers to curl inwards, hindering hand movement. The expected outcome is improved hand function and relief from contracture-related symptoms.

Indications

• Presence of Dupuytren's contracture causing significant hand or finger deformity
• Difficulty in performing daily tasks due to contracture
• Failed non-surgical treatments

Preparation

• Patients may be advised to fast for several hours before the procedure
• Adjustments in medications, especially blood thinners, as advised by the physician
• Pre-operative assessment including blood tests, imaging, and physical examinations

Procedure Description

1. The patient is placed under regional or general anesthesia.
2. An incision is made in the palm to access the diseased tissue.
3. The surgeon removes the affected fascia.
4. Z-plasty or other techniques may be used to rearrange local tissues for better healing and function.
5. If necessary, a skin graft is harvested from another body part and applied to the surgical site.
6. The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity.

Setting

Fasciectomy is usually performed in a hospital or an outpatient surgical center.

Personnel

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

Risks and Complications

• Infection
• Bleeding
• Scarring
• Nerve damage
• Recurrence of contracture
• Delayed wound healing

Benefits

• Improved hand function and mobility
• Relief from pain and discomfort
• Enhanced ability to perform daily activities Benefits often become apparent a few weeks after the surgery, following the initial recovery period.

Recovery

• Keep the hand elevated to reduce swelling
• Follow wound care instructions to prevent infection
• Physical therapy may be required to regain strength and function
• Healing typically occurs in 4-6 weeks, with activity restrictions during this period
• Follow-up appointments to monitor progress

Alternatives

• Non-surgical options like enzyme injections (e.g., collagenase) to dissolve the thickened tissue
• Needle aponeurotomy to break the contracted tissue manually
• Pros and cons of alternatives vary; non-surgical methods may have quicker recovery but may be less effective for severe contractures

Patient Experience

• During the procedure: Anesthesia ensures the patient feels no pain
• After the procedure: Some discomfort and swelling can be expected, manageable with pain medication
• Gradual improvement in hand function and appearance over the recovery period

Pain management strategies and regular follow-ups ensure the patient's comfort and successful recovery.