Limited (regional) fasciectomy for Dupuytren contracture
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Regional (limited) fasciectomy is a surgical procedure used to treat Dupuytren’s contracture. The procedure involves the selective removal of the affected palmar fascia (fibrous nodules and pathological cords) that cause permanent finger flexion. The goal of the surgery is to correct the contracture, improve finger extension, and restore hand function.
Indications
The procedure is recommended when Dupuytren’s contracture causes significant functional impairment or when there is a risk of permanent joint damage.
Common indications include:
- a positive Hueston tabletop test (the patient is unable to place the palm flat on a surface);
- metacarpophalangeal joint flexion contracture of approximately 30° or more;
- proximal interphalangeal joint contracture;
- difficulty performing daily activities (personal hygiene, dressing, wearing gloves, handling objects);
- thumb involvement with impaired grip function;
- rapid progression of the disease;
- involvement of multiple fingers;
- recurrent contracture after previous treatment;
- persistent painful nodules in selected cases.
Procedure / Duration
The procedure is performed under local, regional, or general anesthesia.
The surgeon makes one or more incisions in the palm and/or fingers, identifies and protects the nerves, blood vessels, and tendons, and removes the pathological fascial tissue. Once the contracture has been released, the wound is closed with sutures and a sterile dressing is applied.
The duration of the procedure is determined individually, depending on the complexity of the case.
After surgery, a rehabilitation program, including hand therapy and therapeutic exercises, is recommended to restore hand mobility and function.
Limitations
Fasciectomy corrects the existing contracture but does not eliminate the biological predisposition to Dupuytren’s disease. Therefore:
- the disease may recur in the treated area;
- new fibrous nodules or cords may develop in other areas of the hand;
- full recovery may take from several weeks to several months;
- the outcome depends on the severity of the contracture, joint involvement, and adherence to the rehabilitation program.
Contraindications
Contraindications are determined individually by the surgeon and anesthesiologist based on the patient's overall health and surgical risk.
Benefits
- completely or partially corrects finger deformity;
- improves finger extension and hand mobility;
- enhances hand function and grip strength;
- facilitates daily and work-related activities;
- may help prevent further secondary joint deformities;
- provides good functional outcomes when followed by appropriate postoperative rehabilitation.
Medical sources:
Ministerul Sănătății al Republicii Moldova. Protocol clinic național PCN-452 „Maladia Dupuytren”, aprobat prin Ordinul nr. 21 din 15.01.2026.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10039301/
https://dupuytrens-society.org.uk/treatment-2/dupuytrens-disease/dupuytrens-surgery/
https://www.england.nhs.uk/wp-content/uploads/2022/07/Making-a-decision-about-Dupuytrens-contracture.pdf
https://www.nhs.uk/conditions/dupuytrens-contracture/
Preparation:
Before the procedure, patients should:
- attend a consultation with an orthopedic trauma surgeon or a hand surgeon;
- undergo a pre-anesthetic consultation;
- complete the recommended laboratory tests and diagnostic investigations;
- inform the physician about all medications they are taking, especially anticoagulants and antiplatelet drugs;
- ensure optimal control of underlying medical conditions (such as diabetes mellitus);
- stop smoking if possible;
- follow the anesthesiologist's instructions regarding fasting before surgery.
