What is Palmar Fasciectomy?

Palmar fasciectomy is a surgical procedure used to treat Dupuytren's contracture. The muscles and tendons that control the fingers are held in place by a tough sheet of connective tissue that lies just under the skin of the palm. In Dupuytren's, this connective tissue (or fascia) begins to develop scar tissue, even though it has not been injured. The fascia becomes thick and tough, and knits together into knots. This causes the fingers to become stiff and pull inwards towards the palm. It is not known exactly what causes Dupuytren's, but it is more common in older men, especially those from Northern Europe.

Palmar fasciectomy is the surgical removal of this diseased fascia. Depending on the severity of the disease, some or all of the fascia may be removed. In very severe cases, where the hand has been in a curled position for a long time, skin on the palm or ligaments around the finger joints can shrink so that it is impossible to straighten the fingers. In these cases, skin grafts and additional surgery can be used. The muscles and tendons of the hand are left in place, and without the diseased fascia they are free to move normally.

Because of the delicate nature of the hand, a palmar fasciectomy may take several hours to perform. There may be some pain as the skin and tissue in the hand heals, and you will likely have to wear a splint to keep your fingers straight for several weeks. Physical therapy, including stretches, heat treatments, massage, and exercise, is often prescribed to assist healing. Unfortunately there is no cure for Dupuytren's contracture, and symptoms will come back in about half of the patients who have a palmar fasciectomy. The earlier in the disease the surgery is performed, the less likely it is to come back; so having surgery sooner rather than later is preferable.

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