Dupuytren's Fasciectomy

Why this approach — at MOS

The most important and technically demanding aspect of Dupuytren's fasciectomy is protecting the digital nerves and arteries. In advanced contractures — particularly at the PIP joint — the neurovascular bundles can be tethered by the cord and displaced medially, directly in the path of the dissection. Careful, deliberate dissection under tourniquet control and adequate magnification is essential.

At Maryland Orthopedic Specialists, Dr. Fitzgibbons performs limited fasciectomy — removing the diseased cord without routinely excising the entire palmar fascia. This approach corrects the contracture with a lower complication rate and shorter recovery than complete palmar fasciectomy, and the recurrence rate is acceptable, particularly in older patients with slower-progressing disease.

Post-operative therapy is not optional — it is a core part of the treatment. An extension splint worn nightly for 3–6 months after surgery is essential to maintain the correction achieved during the operation. Patients in the Germantown, Bethesda, and Rockville offices are connected with hand therapy resources to ensure compliance with the post-operative splinting and motion program. Patients who understand that the operation achieves the correction and that therapy maintains it are the ones who do best.

Who is a candidate?

Indications

• Metacarpophalangeal (MCP) joint contracture of 30 degrees or more — the "tabletop test": if the finger cannot lie flat on a table, surgery is typically indicated
• Proximal interphalangeal (PIP) joint contracture of any meaningful degree — PIP contractures are stiffer and harder to fully correct, so earlier intervention is preferred
• Functional limitations: inability to put hand in pocket, wear a glove, or perform flat-hand activities
• Failed or recurred after needle aponeurotomy or collagenase (Xiaflex) injection

Contraindications

• Very early disease with only palmar nodules, no contracture, and no functional limitation
• Significant systemic illness that elevates surgical risk beyond the expected benefit
• Active hand infection
• Patient unwilling to participate in post-operative splinting and hand therapy — both are essential for outcome

Conservative Treatment First

Early Dupuytren's disease (nodules without significant contracture) does not require treatment. Observation is appropriate because many patients have a very slow rate of progression, and surgery before contracture develops offers no advantage.

When contracture begins to develop, two minimally invasive options are available before open surgery. Needle aponeurotomy (percutaneous needle fasciotomy) uses a hypodermic needle to score and break the cord, correcting the contracture without an incision. It is quick, done in the office, and has a fast recovery — but contracture recurrence rates are higher than with fasciectomy. Collagenase injection (Xiaflex) dissolves the cord's collagen and allows the finger to be manually straightened in the office the following day. It is effective for isolated cord bands and avoids surgery, but it is not available for all cord configurations, costs more, and has similar or higher recurrence rates than fasciectomy. When these options fail or are not appropriate for the cord anatomy, fasciectomy provides the most durable correction.

The procedure

What Is Dupuytren's Fasciectomy?

Dupuytren's fasciectomy is surgery to remove the thickened, cord-like tissue in the palm that causes one or more fingers to bend toward the palm and become unable to straighten. The surgery corrects the contracture by excising the diseased fascia. It is used when the finger can no longer be fully extended and daily activities are impaired.

Dupuytren's disease is a condition in which the normal fibrous tissue (fascia) of the palm undergoes progressive fibrotic thickening. It begins as a firm nodule in the palm — often noticed first as a bump at the base of the ring finger — and gradually develops into cord-like bands that extend from the palm into the finger. As these cords tighten over months to years, they pull the affected finger into a flexed position. The ring finger is most commonly affected, followed by the small finger; the middle, index, and thumb can also be involved.

The cause of Dupuytren's disease is not completely understood, but it has a strong genetic component and is most common in men of Northern European descent over the age of 50. Associated risk factors include alcohol use, smoking, manual labor with vibrating tools, diabetes, and certain seizure medications. The disease itself is not dangerous, but the contracture it causes can significantly interfere with handshaking, glove wearing, face washing, and flat-hand activities.

Fasciectomy — surgical removal of the diseased cord and surrounding fascia — is the most reliable surgical treatment for correcting established contractures. It is an outpatient procedure performed under regional or local anesthesia.

What Happens During Dupuytren's Fasciectomy?

Setting: Dupuytren's fasciectomy is performed on an outpatient basis. Regional anesthesia (a brachial plexus or forearm block) or local anesthesia with sedation is used. Operating time ranges from 45–90 minutes depending on the extent of cord involvement.

Incision: A zigzag (Bruner) incision is made along the palm and finger, following the skin creases. This design allows wide exposure while minimizing the risk of scar contracture across the creases. In some cases, transverse incisions with V-Y plasty closures are used.

Cord excision: The thickened Dupuytren's cord is meticulously dissected from the surrounding normal tissue and from the digital nerves and blood vessels, which are intimately intertwined with the cord as it passes into the finger. The digital nerves are the primary risk in this procedure — they are carefully identified, preserved, and protected throughout the dissection. The diseased fascial cord is excised. In a partial fasciectomy (the most common approach), the visible, diseased cord is removed. In a complete regional fasciectomy, a wider area of fascia is removed in an attempt to reduce recurrence — though this is associated with more complications and longer recovery.

Closure: The incision is closed, sometimes with skin grafting if the skin overlying the cord is too involved with disease to close directly. A bulky dressing and a plaster splint holding the fingers in full extension are applied.

Recovery room: The hand is elevated, and pain is typically well controlled. You are discharged the same day.

Recovery timeline

Frequently Asked Questions