Fasciectomy

What is a fasciectomy?

A fasciectomy (fash-ee-EK-tuh-mee) is a surgical procedure to remove fascia (a fibrous layer of tissue) in your hand that tightens from Dupuytren’s disease. This condition causes one or more of your fingers to involuntarily curl toward your palm. In severe cases, you can’t straighten your fingers. Your fingers relax after a fasciectomy, improving your hand function.

What is Dupuytren’s disease?

Dupuytren’s disease is a progressive connective tissue disorder. It causes fascia in one or both hands to become thick and tight. Your connective tissues are part of your musculoskeletal system. They support your muscles, organs, joints and skin. Some people inherit a gene change (mutation) from a parent that causes Dupuytren’s disease. For others, the disease occurs for no known reason.

People with Dupuytren’s disease develop nodules, or small lumps of tissue, on the fascia that holds the skin in place on the palm of the hand. Over time, thick cords of tissue form. These cords pull one or more fingers (and less commonly, your thumb) toward your palm. Your healthcare provider may call this Dupuytren’s contracture.

Who needs a fasciectomy?

Dupuytren’s disease is a chronic, progressive disease. Your healthcare provider will try nonsurgical treatments, first. These may include injections of steroids or collagenase (an enzyme). Still, you may develop severely bent fingers that affect how well you can use your hand. At this point, your provider may discuss surgical options like a fasciectomy or a fasciotomy.

What’s the difference between a fasciectomy and fasciotomy?

Surgical treatments for Dupuytren’s disease include:

• Fasciotomy: Your provider makes a small incision in your palm and separates the thickened cord of tissue. This division weakens the tissue, improving your ability to bend and move your fingers.
• Percutaneous needle fasciotomy: Also called a needle aponeurotomy, your provider uses a small needle to make holes in (perforate) the thickened tissue. The holes weaken and break apart the tissue, so you can move your fingers better.
• Fasciectomy: A fasciectomy (also called palmar fasciectomy) removes the nodules and cords of tissue that pull on your thumb and fingers.

Who performs a fasciectomy?

Orthopaedic hand surgeons typically perform fasciectomies. Orthopaedic surgeons specialize in the surgical treatment of musculoskeletal disorders. Hand surgeons are orthopaedic surgeons who have completed advanced training in hand procedures.

What happens before a fasciectomy?

You should follow your surgeon’s instructions on the steps to take before the procedure. You may need to:

• Fast (not eat or drink) before surgery.
• Quit smoking.
• Stop taking certain medications, including vitamins and herbal supplements.

What’s the difference between a partial fasciectomy and a total fasciectomy?

A partial or subtotal fasciectomy removes only the affected tissue. A total fasciectomy removes all the fascia, even healthy tissue. Your surgeon will discuss options with you and select the most effective treatment for your unique situation.

What are the types of fasciectomies?

Surgeons can perform a fasciectomy using different methods. Specific types of fasciectomy procedures include:

• Segmental (partial) fasciectomy: Your surgeon makes a few small incisions in the natural creases of your hand. They separate the thickened tissue from nearby tendons and nerves, removing a short section of the affected tissue cord.
• Subtotal palmar fasciectomy: Your surgeon makes several incisions (often in a zigzag pattern) along the creases in your palm and fingers. They remove as much diseased tissue as possible. You may need a skin graft to help the wounds heal.
• Dermofasciectomy: This treatment for recurring Dupuytren’s contracture involves removing diseased fascia tissue along with some of the skin from your palm. You will need a skin graft.

What happens during a fasciectomy?

A segmental fasciectomy is typically an outpatient procedure. This means you go home the same day. You may receive regional anesthesia to numb your upper body. Your surgeon may leave the small wound open (no stitches) to let it drain and heal naturally. You’ll wear a bandage to lower the risk of infection.

Subtotal palmar fasciectomies and dermofasciectomies are more complicated procedures. They often require skin grafts. You may receive general anesthesia to sleep through the procedure. There is a greater risk of infection after a skin graft, so you may stay overnight in the hospital.

What are the benefits of a fasciectomy?

A fasciectomy can help you regain function of your hand, fingers and thumb. The removal of the affected fascia allows you to stretch and straighten your digits. Some studies suggest that the treatment is more effective than a fasciotomy or needle aponeurotomy with longer-lasting results.

What are the risks of a fasciectomy?

Some loss of sensation or numbness in your fingers after a fasciectomy is normal. This temporary problem should improve as contracted nerves begin to stretch. In extremely rare instances, damage to nearby nerves or blood vessels may permanently affect your ability to use a finger. You may need an amputation.

Other potential complications of a fasciectomy include:

• Allergic reaction to anesthesia.
• Infections.
• Skin sensitivity and scars.
• Bruising.
• Swelling (edema).

What is recovery like after a fasciectomy?

You’ll have some pain, swelling and stiffness after surgery. You may also feel some tingling or numbness in your hand and fingers, which may take a few months to go away. Depending on the type of work you do, you may need to take two to 12 weeks off work.

You should follow your provider’s recommendations for incision care and recovery. These may include:

• Applying an ice pack and keeping your hand elevated.
• Cleaning the wound with soap and water — and covering it with a bandage.
• Keeping your hand and stitches dry while showering.
• Participating in physical therapy (hand therapy) and practicing your exercises at home.
• Taking medications like antibiotics and pain relievers.
• Wearing a splint for up to 12 weeks.

Does a fasciectomy cure Dupuytren’s disease?

Surgery won’t cure the disease, but it can improve hand function. Approximately 2 out of 10 people will experience some recurrence of Dupuytren’s contracture after a fasciectomy. You may need another surgery.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Allergic reaction like an itchy rash (contact dermatitis).
• Chest pain or shortness of breath.
• Inability to feel or move your fingers.
• Severe muscle pain.
• Signs of infection, such as fever, yellow discharge or red streaks.

A note from Cleveland Clinic

Severely bent fingers from Dupuytren’s disease can affect your ability to work and complete daily functions like showering and getting dressed. Your healthcare provider may recommend a fasciectomy to help you have better use of your fingers and hands. An orthopaedic hand surgeon typically performs a fasciectomy. After surgery, it’s important to do physical therapy and hand exercises. You may also wear a splint. Sometimes, Dupuytren’s contracture returns after a fasciectomy. You may need another surgery.