fasciectomy

Fasciectomy is a surgical procedure that removes diseased fascia to restore mobility. The term most often refers to removal of the palmar fascia in Dupuytren's contracture, a condition in which thickened fascia causes progressive finger flexion contractures. The procedure may also be used for other fascial diseases.

Indications include finger contractures due to Dupuytren's disease, where the aim is to release the affected fascia to straighten the fingers. The extent ranges from limited (partial) fasciectomy to more extensive resections or dermofasciectomy when skin is involved or recurrence has occurred.

Technique: Open fasciectomy is performed under regional anesthesia or general anesthesia. The surgeon makes incisions along the palm to expose diseased fascia, carefully preserving digital nerves and vessels, and excises the affected fascia. In some cases, limited excision or dermofasciectomy with skin grafting is used.

Outcomes and recovery: Many patients experience improved finger extension and function after fasciectomy, with rehabilitation and splinting guiding recovery. Recurrence of contracture is common over years and may necessitate further treatment.

Complications: Potential risks include infection, hematoma, wound dehiscence, nerve or vessel injury, stiffness, and scar tenderness. More extensive procedures carry higher risk, including complex regional pain syndrome.

Alternatives: Nonoperative approaches include collagenase injections and needle fasciotomy, which may offer quicker recovery but higher recurrence in some cases. More radical options such as dermofasciectomy are reserved for recurrent or extensive disease.