Partial Palmar Fasciectomy for Dupuytren Disease
Introduction
Dupuytren disease is a benign fibroproliferative disorder of the palmar fascia
Differentiate from non-Dupuytren disease fascial proliferation secondary to trauma
Patient Selection
Indications for Treatment for Dupuytren Disease Include the Following
Metacarpophalangeal joint contracture of at least 30°
Proximal interphalangeal joint contracture of 15°
Limitation of function due to prominent cords or nodules
The “table top test” is a useful way to counsel patients regarding treatment—if patients cannot place the hand flat on table, intervention may be considered
Contraindications
Non-Dupuytren disease
Open hand wound
Infection
Low functional demands; no benefit from surgery
Psychologically unfit for surgical procedure
Caution with patients on anticoagulation that cannot be stopped; risk of hematoma
Alternatives to Surgical Treatment
Needle aponeurotomy
Collagenase injection
Preoperative Imaging
Not routinely obtained
Plain radiographs of the hand may be considered in those with underlying degenerative disease
Procedure
Room Setup/Patient Positioning
Supine position with arm on hand table
Nonsterile padded tourniquet to upper arm
Prepare volar forearm in case graft needed
Position body to allow access to flaps as needed
Anesthesia may be general, regional, or local
Special Instruments/Equipment
Lead hand can help with exposure
No. 15C Bard-Parker surgical blade
Small Beaver blade scalpels
Microscope available in case of injury to nerves or arteries
Surgical Technique
Preoperative Planning
Figure 1Photograph depicts metacarpophalangeal joint flexion contracture due to pretendinous cords in the palm.
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