Treatment of Dupuytren's Contracture – Restoring Hand Function

Surgical Release of Contracture – Purpose and Essence of the Method

Surgical treatment of Dupuytren’s contracture, most commonly in the form of fasciectomy (excision of the diseased palmar fascia) or fasciotomy (incision of the fascial bands), aims to remove or separate the thickened connective tissue that causes flexion contracture of the fingers. This precise procedure allows for the release of tendons and joints, which directly restores the ability to straighten the fingers and grasp objects.

Who is this surgical procedure intended for?

The procedure is intended for individuals who:

• Have a permanent contracture of one or more fingers,
• Have an advanced stage of the condition, with a contracture angle in the joints exceeding 30–45 degrees (inability to place the hand flat on a table—the so-called “table test”),
• The contracture significantly limits hand function and hinders daily activities (e.g., washing, dressing, writing),
• Conservative treatment (e.g., physical therapy, medication) has not produced the expected improvement.

Course of treatment

Before treatment:

• Consultation with a hand surgeon and evaluation for surgery.
• Determining and discussing the scope of the surgery and the type of anesthesia.
• Conducting basic laboratory tests (including complete blood count and coagulation profile).
• Fasting (6 hours without food, 4 hours without drink) on the day of the procedure.

During the procedure (fasciectomy):

• Administration of anesthesia (local or regional—nerve block).
• Making an incision in the skin of the hand (often zigzag-shaped to minimize tension).
• Dissection of tissues and identification of the pathologically altered palmar fascia strands.
• Removal (fasciectomy) or incision (fasciotomy) of the affected tissue strands.
• Verification of the ability to fully extend the fingers.
• Placement of sutures and a sterile dressing (sometimes with a plaster splint to stabilize the fingers in the extended position).

After treatment:

• Brief observation at the clinic.
• In most cases, discharge home on the same day (same-day surgery).
• Elevate the arm above heart level and cool the operated area (to reduce swelling).
• Regular dressing changes.
• Follow-up visits (usually after 7–14 days to have the sutures removed).
• Begin rehabilitation and physical therapy (crucial for a full return to function).