Dermofasciectomy

Dermofasciectomy is a surgical procedure used primarily for Dupuytren's contracture. In this operation, the diseased palmar fascia and the overlying skin that is involved with the contracture are removed as a single specimen (en bloc). This approach aims to excise the pathological tissue more completely, particularly in recurrent disease where skin involvement or previous surgery has compromised tissue quality. It is more extensive than a standard fasciectomy and is typically considered when there is extensive fibrosis, skin involvement, or after failure of prior procedures.

During the surgery, an incision is made in the palm, and the diseased palmar fascia, along with any affected skin, is carefully dissected and excised. The resulting skin defect is then covered with a skin graft, usually a full-thickness or split-thickness graft harvested from another site such as the groin or thigh. In some cases, local flaps may be used for coverage.

Postoperative care includes immobilization in partial extension to protect the graft, followed by hand therapy to restore motion. The procedure can reduce contracture and improve finger extension, but recurrence of Dupuytren's disease can occur. Complications are more common than with less extensive fasciectomy and can include graft loss or failure, infection, wound healing problems, stiffness, and sensory changes around the incision.