26123 Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)

Name of the Procedure:

Fasciectomy, Partial Palmar with Release of Single Digit including Proximal Interphalangeal Joint
Common Names: Palmar Fasciectomy, Dupuytren's Contracture Release

Summary

In a partial palmar fasciectomy, the surgeon removes diseased tissue from the palm and finger, often due to Dupuytren’s contracture. This can also involve joint release and potentially Z-plasty or grafting to restore finger function.

Purpose

The procedure addresses Dupuytren's contracture, a hand deformity that affects the tissue beneath the skin of the palm and fingers. The goal is to remove the thickened tissue to improve hand function and alleviate symptoms such as bent fingers that can't be straightened completely.

Indications

• Noticeable thickening and tightening of the palm tissue, leading to bent fingers.
• Reduced hand function impacting daily activities.
• Patients who haven't responded to non-surgical treatments.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Adjustments to medications, especially blood thinners, may be required.
• Preoperative assessments might include physical evaluations and imaging tests of the hand.

Procedure Description

1. Anesthesia: Local, regional, or general anesthesia to numb the area or put the patient to sleep.
2. Incision: A small incision is made in the palm and possibly the affected finger.
3. Tissue Removal: The surgeon removes the diseased fascial tissue causing contracture.
4. Joint Release: If needed, the surgeon releases the proximal interphalangeal joint.
5. Z-Plasty or Grafting: Local tissue rearrangement or skin grafting may be performed to cover defects.
6. Closure: The incision is closed with sutures, and the area is bandaged.

Duration

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

Setting

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

Personnel

• Surgeon: Performs the operation.
• Anesthesiologist: Manages anesthesia.
• Nurses: Assist during surgery and provide pre/post-operative care.

Risks and Complications

• Common Risks: Infection, bleeding, pain, and swelling.
• Rare Risks: Nerve damage, delayed healing, reduced hand function, or recurrence of contracture.
• Management includes antibiotics, pain medications, physical therapy, or additional surgical interventions if necessary.

Benefits

• Improved hand function, enabling better performance of daily activities.
• Straightened fingers and relief from discomfort.
• Benefits typically observed within weeks to months post-surgery.

Recovery

• Post-Procedure Care: Keeping the hand elevated, managing pain with prescribed medications, and regular wound care.
• Recovery Time: Around 6 to 12 weeks for full recovery, but light activities can resume in a few days.
• Restrictions: Avoid heavy lifting and strenuous activities. Follow-up appointments for suture removal and monitoring.

Alternatives

• Non-Surgical: Physical therapy, corticosteroid injections, and enzyme injections (collagenase).
• Surgical: Needle aponeurotomy or more extensive surgical fasciectomy.
  • Pros: Less invasive options may be tried initially.
  • Cons: Non-surgical options might be less effective for severe cases.

Patient Experience

During the procedure, the patient might feel minimal discomfort due to anesthesia. Post-surgery, there may be pain and swelling, managed with medications. Follow-up care includes physical therapy to regain strength and flexibility.