Dupuytren's fasciectomy is an operation to remove thickened tissue (fascia) in the palm of the hand that is pulling one or more fingers into a bent position. It aims to straighten the affected fingers and restore hand function.
An incision is made in the palm and sometimes extended into the affected finger. The thickened, contracted cord of fascia is carefully dissected away from the surrounding tendons, nerves, and blood vessels, and removed. The skin is closed, sometimes with a skin graft if the contracture is severe. A splint or dressing is applied. The operation takes 30–90 minutes depending on the extent of disease.
Surgery is recommended when the contracture prevents the finger from straightening fully, causing functional problems such as difficulty putting the hand flat on a table, putting on gloves, or gripping objects. Surgery is generally considered when the contracture reaches approximately 30 degrees or more at the metacarpophalangeal joint, or when the proximal interphalangeal joint is affected.
Needle fasciotomy — a procedure where a needle is used to divide the cord through the skin without open surgery. Collagenase injection (where available) to dissolve the cord. These are less invasive but carry a higher recurrence rate. Observation is appropriate for disease that is not causing functional limitation.
Pre-assessment may be required depending on your health. This is usually a day-case procedure. Remove rings from the affected hand. Plan for limited hand use for several weeks.
The aim is to straighten the affected finger and improve hand function. Most patients achieve significant improvement in finger position. However, Dupuytren's is a progressive condition and recurrence is possible over time. Complete straightening may not always be achievable, particularly when the contracture has been present for a long time.
Dupuytren's disease may recur in the same or different fingers over time. The recurrence rate varies but can be 20–50% over 10 years.
Finger stiffness is common after surgery and requires dedicated physiotherapy.
The skin in the palm may heal slowly, particularly if a skin graft is needed.
Expected in the hand for the first few weeks.
The digital nerves may be displaced by the disease and are at risk during surgery. Numbness in the finger can result.
The digital arteries may also be displaced and at risk.
Wound infection requiring antibiotics.
A rare complication causing chronic pain and stiffness.
Excessive swelling and stiffness in the early weeks that delays recovery.
Performed under general anaesthesia, regional arm block, or sometimes local anaesthesia with a tourniquet. Your surgeon and anaesthetist will advise the best option.
A splint is usually worn at night for several weeks to maintain the correction. Hand therapy (physiotherapy) is essential to regain movement and prevent stiffness. Stitches are removed at 10–14 days. Light activities resume within two to three weeks. Full recovery typically takes six to twelve weeks. Hand therapy is a crucial part of the process.
Wound review and suture removal at 10–14 days. Hand therapy begins in the first two weeks. Surgeon review at six weeks.
Dupuytren's is a progressive condition and can recur. The recurrence rate depends on factors including age, family history, and disease severity. Younger patients tend to have higher recurrence rates.
If the contracture has been present for a long time, the joint itself may have adapted and full straightening may not be achievable. The surgeon will discuss realistic expectations with you.
Needle fasciotomy is a less invasive alternative. It is suitable for some patients but has a higher recurrence rate than open fasciectomy.