What is fasciectomy for dupuytren's contracture?

Fasciectomy (say "fash-ee-EK-tuh-mee") is surgery to cut out a layer of tissue called the fascia (say "FASH-ee-uh") that lies deep under the skin. In Dupuytren's (say "doo-pwee-TRAHNZ") contracture, the fascia of the palm of the hand becomes thick and tight. This causes the fingers to become stiff and to curl toward the palm. Removing the fascia can help relax the fingers.

This surgery may be done while you are asleep or while you are awake. If you are awake, you will get medicine to numb your hand and prevent pain. You may also get medicine to help you relax.

The doctor will make a cut, called an incision, in the skin of your palm. The thickened fascia will be removed. The doctor will close the incision in your palm with stitches. After surgery, you will have a scar on your palm and on one or more fingers. This will fade with time.

You will go home on the same day as the surgery. It will probably take about 6 weeks for your hand to heal. How soon you can return to work depends on your job. If you can do your job without using your hand, you may be able to go back in 1 to 2 weeks. But if your job requires you to do repeated finger or hand movements, put pressure on your hand, or lift things, you may need to take 6 to 12 weeks off work.

For the first few weeks after surgery, you will probably need to wear a splint. You may need to do hand exercises to help reduce the swelling and stiffness. After several weeks, your hand and fingers may be more flexible. You may be better able to fully open your hand.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk.
• Do not use your hand until after the incision has healed, usually about 2 weeks after surgery. This includes lifting things heavier than 1 to 2 pounds or doing repeated finger or hand movements, such as typing, using a computer mouse, washing windows, vacuuming, or chopping food. Do not use power tools, and avoid other activities that make your hand vibrate. Your doctor or your physical or occupational therapist will tell you when it is okay to use your hand again.
• Ask your doctor when you can drive again.
• You will probably need to take at least 1 to 2 weeks off from work. It depends on the type of work you do and how you feel.
• You may shower, but do not get your hand wet until your doctor says it is okay. Keep the bandage dry by covering it with plastic. Do not take a bath, swim, use a hot tub, or soak your hand until your doctor says it is okay.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• Leave the bandage on your hand until the doctor says it is okay to remove it. This is usually 2 or 3 days after surgery.
• After the doctor says you can take off your bandage, wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Exercise

• Gently bend and straighten your fingers throughout the day to keep them flexible and to help reduce swelling.
• Do your hand therapy as directed by your doctor or your physical or occupational therapist. This can help you regain flexibility and strength in your hand and fingers. To get the best results, you need to do the exercises correctly and as often and as long as your doctor or your physical or occupational therapist tells you to.

Ice and elevation

• Put ice or a cold pack on your hand and wrist for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake) or until the swelling goes down. Put a thin cloth between the ice and your skin.
• Prop up your hand on a pillow anytime you sit or lie down during the first 2 or 3 days after surgery. Try to keep the hand above the level of your heart. This will help reduce swelling.
• Wear a sling to support your hand, if your doctor tells you to. Make sure to move your arm and shoulder often if you wear a sling. This will help prevent your elbow and shoulder from getting stiff.

Other instructions

• For the first day or two after surgery, you may have a tube near your incision to drain fluids. Your doctor will tell you how to take care of it.
• Wear your hand splint as directed by your doctor.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Fasciectomy (say "fash-ee-EK-tuh-mee") is surgery to cut out a layer of tissue called the fascia (say "FASH-ee-uh") that lies deep under the skin. In Dupuytren's (say "duh-pwee-TRAHNZ") contracture, the fascia of the palm of the hand becomes thick and tight. This causes the fingers to become stiff and to curl toward the palm. Removing the fascia can help relax the fingers.

Your hand and fingers may be swollen for the first few days. Most people need pain medicine for about a week after surgery. You may feel numbness or tingling near the cut, called an incision, that the doctor made. This feeling will probably start to get better in a few days, but it may take several months to go away. Your doctor will take out your stitches about 2 weeks after your surgery.

How soon you can return to work depends on your job. If you can do your job without using the hand, you may be able to go back in 1 to 2 weeks. But if your job requires you to do repeated finger movements, put pressure on your hand, or lift things, you may need to take 6 to 12 weeks off work. Your doctor can help you decide how much time you will need to take off work.

An important part of recovery is hand therapy. Work with your physical or occupational therapist and practice hand exercises at home to help your fingers become more flexible. Hand therapy may also help prevent future problems. Most people need to do hand therapy for several months. You also may need to wear a hand splint for 6 to 12 weeks after surgery.

After surgery and hand therapy, your hand and fingers should be more flexible. Many people get better without any problems. But it's possible that the fascia may become thick and tight again. Even if this problem comes back, it's usually not severe enough that another surgery is needed.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery usually takes 30 minutes to 2 hours.
• You will have a thick bandage on your hand, wrist, and fingers. You will not be able to move your finger.
• You will probably go home after 1 to 2 hours in the recovery room.