Name of the Procedure:

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); each additional digit (List separately in addition). Common term: Partial Palmar Fasciectomy.

Summary

A partial palmar fasciectomy is a surgical procedure to release a contracted finger and improve hand function. This involves removing part of the thickened fibrous tissue (fascia) in the palm and finger to allow for better movement of the finger.

Purpose

This procedure primarily addresses conditions like Dupuytren's Contracture, where abnormal thickening of the fascia causes fingers to bend towards the palm. The goal is to straighten the affected finger(s) and restore hand functionality.

Indications

• Persistent finger contracture that impedes hand function.
• Severe Dupuytren's Contracture unresponsive to non-surgical treatments.

• Pain or skin problems due to contracture.

  Preparation

• Pre-surgery fasting (usually 6-8 hours).
• Possible adjustments of current medications (e.g., blood thinners).
• Preoperative blood tests and hand imaging (e.g., X-rays, MRI).

Procedure Description

1. The patient is administered regional or general anesthesia.
2. An incision is made along the palm and affected finger.
3. The surgeon removes or releases the thickened fascia.
4. Techniques like Z-plasty or skin grafting may be used for optimal closure and flexibility.
5. Layers of skin are stitched closed carefully.

Duration

The procedure typically takes 1 to 2 hours, depending on the number of digits involved.

Setting

Usually performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic or Plastic Surgeon
• Anesthesiologist
• Surgical Nurses
• Possibly a Physical Therapist for post-surgery recovery

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve damage causing numbness or tingling
• Stiffness or recurrence of contracture
• Adverse reactions to anesthesia

Benefits

• Improved finger movement and hand function.
• Reduction of pain and discomfort.
• Enhanced ability to perform daily tasks.

Benefits may be noticeable shortly after recovery and physical therapy, typically within a few weeks.

Recovery

• Keep the hand elevated to reduce swelling.
• Follow physician’s instructions on wound care.
• Physical therapy may be necessary for several weeks.
• Avoid strenuous activities with your hand for about 4 to 6 weeks.
• Follow-up appointments to monitor progress and remove stitches if needed.

Alternatives

• Non-surgical options like steroid injections, needle aponeurotomy, or enzyme injections (e.g., collagenase).
• Pros: Less invasive, quicker recovery.
• Cons: May be less effective for severe cases, possible recurrence.

Patient Experience

The patient may feel discomfort or mild pain post-surgery, managed with prescribed pain relief medications. Swelling and limited hand function might occur initially but improve with physical therapy. Initially uncomfortable, the procedure significantly improves quality of life once recovery is complete.