Hardened nodules and strands are removed with fasciectomy surgery. These can be found in the area of the tendons on the palm and on the sole of the foot. The nodes and strands on the hand are the result of a tissue disease known as Dupuytren's contracture. The tissue disease on the sole of the feet is known as Ledderhose's disease. On the hand, the disease leads to the finger not being able to stretch. Nodules on the sole of the feet influence the ability to walk.
A fasciectomy is a surgical procedure to treat Dupuytren's disease, resp. Ledderhose's disease. Dupuytren's contracture affects the palmar plate (palmar aponeurosis) in the palm and causes the connective tissue to thicken with nodular, string-like growths. As a result, the fingers contract progressively further into a bent position and can no longer be fully extended. With a surgical procedure known as fasciectomy or aponeurotomy, the hardened tissue is severed and removed. The patient can move the tendons more freely and extend their fingers again. Ledderhose's disease affects the plantar fascia (plantar poneurosis) on the soles of the feet.
What preparations are carried out before the procedure?
Before the operation, the affected hand is thoroughly examined and x-ray images or MRI images are prepared.
Antihaemorrhagic agents are discontinued a few days beforehand. As is customary before operations, blood tests, an ECG and blood pressure measurements are also undertaken. Patients should be fasting for the procedure.
How is the operation carried out?
The procedure is usually carried out with regional anaesthesia.
Depending on which parts of the hand are affected, the incision is made in the palm or in the centre line of the finger. After opening the palm or the finger, all the nodules and strands are removed. The procedure is usually a partial fasciectomy. This means that the entire layer of tendons is not removed. After closing the surgical wound, a pressure pad is inserted into the bandage to prevent a haematoma from occurring. The operation takes approx. one hour. The tissue nodules are removed surgically, as those on the hand, to treat Ledderhose's disease.
What is the success rate of this procedure?
The success rates of the fasciectomy during Dupuytren's contracture or Ledderhose's disease depends on different factors. The earlier the surgery takes place, the better the success rates are. Extension malfunctions in the joints at the base of the fingers are usually fully remedied with the procedure. However, if the middle joint of the finger is affected, the surgery often does not bring back full extension to the finger.
What are the possible complications and risks of this procedure?
Even if the surgery is conducted carefully, it can damage the nerves or blood vessels in rare cases. After the surgery, the connective tissue can sometimes reharden with nodules and strand formation. In such cases, further surgery is required.
What happens after the operation?
After fasciectomy, the operated hand is rested in a splint. Initial physiotherapy exercises are already undertaken on the day of the operation. The exercises must be done regularly to regain full extension of the finger. The hand can be quickly used again for all daily activities such as body care or dressing. People who have undergone this surgery should avoid major physical exertion in the first three to four weeks. The hand can be used as normal after approx. six weeks.
