Dupuytren’s Fasciectomy

Chapter 24 Dupuytren’s Fasciectomy



Carol Page, PT, DPT, CHT


Dupuytren’s disease is a condition of increased fibrous tissue growth in the hand, characterized by nodule and cord formation. The changes in the palmar and digital fascia result in flexion contractures of the proximal interphalangeal (PIP) and metacarpophalangeal (MP) joints. The distal interphalangeal (DIP) joints may also become contracted. Although any of the digits can be involved, the fourth and fifth fingers are most commonly affected. As the flexion contractures progress, hand function becomes increasingly impaired.


Although Dupuytren’s disease is considered to be idiopathic, there is evidence of a genetic component. The disorder occurs more commonly in Northern European populations, particularly in men and with advancing age. Additional links have been made with diabetes, epilepsy, alcohol use, and cigarette smoking.



Surgical Overview



• Dupuytren’s disease typically presents with a nodule in the palm of the hand.

• The disease progresses more quickly in some individuals than others.
1 The normal fibrous tissue changes into fibrous cords that form longitudinally along the lines of tension placed on the tissue with hand motion and use.

2 Formation of the cords causes joint contractures of the MP and PIP joints.

• Indications for surgical intervention include impairment of hand function as a result of digital flexion contractures and demonstrated disease progression.

• Impairment of digital extension may interfere with the ability to perform various functions, such as reaching into pockets, purses, and briefcases, and opening the hand for face washing and hand shaking.

• The purpose of surgery is to restore the ability to straighten the digits to promote hand function.

• The surgical approach to treating contractures resulting from Dupuytren’s disease ranges from the less frequently performed simple fasciotomy, the division of contracted tissue, to various types of fasciectomy.

• In a limited fasciectomy, the diseased tissue in the digits is excised.

• In a radical fasciectomy, the diseased palmar fascia is excised in addition.

• A dermofasciectomy, in which the skin as well as the diseased fascia are excised, may be performed in the attempt to minimize the rate of recurrence.

• Closure of surgical incisions is handled in several ways. The incisions made on the digits are usually primarily closed, and the surgical wounds on the palm are either left open to heal by secondary intention or primarily closed, with or without skin grafting.


Rehabilitation Overview



• Preoperative rehabilitation for Dupuytren’s contracture has not been demonstrated to be effective and is therefore not indicated. However, rehabilitation is widely recognized to be a critical component in a successful postoperative outcome.

• The purpose of postoperative therapy is to use interventions, such as scar and edema management techniques, splinting, and therapeutic exercise, to promote motion, strength, and function.

• Scar management is particularly important to prevent loss of digit extension gained in surgery and flexor tendon adherence.
1 Extension splinting, which is used throughout the course of therapy, continues at night until scar tissue is mature to prevent recurrence of flexion contractures resulting from scar contraction.

2 Although passive motion is helpful for regaining motion, it should never substitute for the active gliding of the tendons that can adhere in the scarred region, causing impairment of hand function.

3 Continuous passive motion machines have not been found to be useful for this diagnosis and are therefore not recommended.

• Therapists treating patients following Dupuytren’s fasciectomy need to be on the alert for the onset of complications and communicate with the referring surgeon if signs are present.
1 The most common complications are hematoma, skin loss, loss of digital flexion, and complex regional pain syndrome (formerly known as reflex sympathetic dystrophy).
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Jun 22, 2016 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Dupuytren’s Fasciectomy

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