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Fasciotomy or Fasciectomy for Dupuytren’s Contracture

A fasciotomy or fasciectomy is a surgical treatment option for certain conditions like Dupuytren’s contracture, also known as Morbus Dupuytren or Viking disease. This condition causes one or more fingers to bend into the palm and prevents it/them from extending. It most commonly affects the ring and little fingers. Sometimes the middle finger may be affected if the condition is severe. The index finger and thumb are usually unaffected. This condition progresses slowly over several years and is accompanied by occasional pain. It tends to occur in patients over 40 years of age and is more common in men than women.

Symptoms
  1. Abnormal thickening of the skin of the palm, causing the finger(s) to bend into the palm and preventing normal extension of the fingers.
  2. Tenderness in small nodules that occur on the palm due to the hardening and thickening of connective tissue under the skin.
There is no clear evidence for the causes or risk factors for Dupuytren’s contracture, but the following are possibilities:
  1. It tends to occur in diabetics, alcoholics, epileptics being treated with phenytoin, and those suffering from liver disease.
  2. Hand injuries or certain occupations may put you at higher risk for developing Dupuytren’s contracture due to overuse of the hand, but the condition does not only occur in the dominant hand.
  3. It is found more frequently in men than women and usually occurs in those over 40. It occurs more commonly in those with a family history (60%) and those with cirrhosis (70%).
  1. From medical history and the symptoms mentioned previously.
  2. From a tabletop test that assesses if the patient can spread their fingers to place their palm directly onto the top of the table. If they are not able to do so, the doctor will grade the condition as mild, moderate, or severe, depending on the bending of the palm.
  1. The doctor will assess the severity of the condition and determine the appropriate surgery.
  2. You will likely need to avoid food and water for at least six to eight hours before the procedure or as recommended by the doctor.
  1. The doctor will decide if general anesthesia or local anesthesia should be used.
  2. A tourniquet will be placed to prevent blood from circulating to the arm.
  3. The doctor will make a zig-zag incision in the skin and remove the thickened connective tissue that is preventing the joint from extending. The incision will then be stitched close.
  4. Sutures will be removed at a follow-up appointment 10-14 days after the procedure.
  1. The doctor will apply a loose bandage that must remain in place for approximately one week. Do not get the bandage wet.
  2. After dressing the wound, use a sling to support the arm.
  3. You will be recommended to practice opening and closing your affected hand after the anesthesia wears off.
  4. You will be able to use your hand normally four weeks after the procedure.
  5. Once your incision heals, massage the scar regularly to soften it and prevent scar tissue from forming.
  1. Injury to the digital nerve (3.4%).
  2. Damage to small blood vessels (2%).
  3. Infection (2.4%).
  4. Hematoma (2.1%).
  5. Pain (5.5%).
Before the Procedure
  • You will undergo a physical examination and be given a diagnosis before treatment can be planned. Surgery, if required, will be done as soon as you are ready. This may mean waiting one to two days or as little as 24 hours.
  • It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure.
After the Procedure
  • You should plan to stay in Thailand for at least one week through the duration of the treatment. This may vary from person to person, depending on your individual health and medical condition before the procedure as well as your age. Certain factors may require a longer stay in Thailand.
  • When you return for your follow-up appointment you will undergo a physical examination and your wound will be checked. You will receive documentation of your treatment history, a medical certificate, and your “fit to fly” certificate.
  • You may travel by car, but keep your affected hand elevated above your heart.
  • Normally patients can travel home by air. Please discuss this with your doctor to confirm that you are healthy enough to fly before making flight arrangements. Be sure to let the airline know in advance if you will need a wheelchair at the airport and when you get off the airplane at your destination.
    • If you are traveling in First or Business class:
      • You can adjust or recline your seat normally. Exercise your leg muscles regularly while you are in the air by flexing and pointing your toes. Take 10 consecutive long deep breaths every hour to improve blood circulation.
      • Drink at least 2,000 to 2,500 milliliters of water each day. Avoid caffeine, sedatives, and alcohol.
      • If you have been instructed to wear a sling, be sure to keep it on through the duration of your flight. You may remove it when you recline your seat to sleep.
    • If you are traveling in Economy Class, be sure to select a seat in the exit row or a bulkhead seat.
      • You can recline your seat normally. Exercise your leg muscles regularly while you are in the air by flexing and pointing your toes. Take 10 consecutive long deep breaths every hour to improve blood circulation. Please get up and move around at least every 30 minutes.
      • Drink at least 2,000 to 2,500 milliliters of water each day. Avoid caffeine, sedatives, and alcohol.
      • If you have been instructed to wear a sling, be sure to keep it on through the duration of your flight.
The success of this procedure depends on many factors. Please talk to your doctor about the possible results of this procedure.
 
What if the procedure is not performed?
Please talk to your doctor about the risks of this treatment as well as alternatives.
 
Treatment options depend on the severity of the problem. Some patients may require multiple treatment methods or repeated treatment. Physical therapy may be an option when symptoms are mild.

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