Specialized Surgical Care for Dupuytren’s Palmar Fibromatosis
Dupuytren’s contracture is a progressive fibroproliferative disease of the palmar aponeurosis that leads to the formation of dense collagen nodules and cords in the palm and fingers. Over time, these pathological cords shorten and draw the fingers (most commonly the ring and little fingers) into an irreversible bent position toward the palm. Patients become unable to lay their hand flat on a table (positive Hueston table-top test), shake hands, wash their face, or put on gloves.
The Limited Selective Fasciectomy Technique
Dr. Vishal Purohit performs precise limited selective fasciectomy under optical magnification:
- Bruner Zig-Zag Incisions: Placing geometric zig-zag incisions along the natural flexion creases of the palm and digits to prevent postoperative longitudinal scar contractures.
- Digital Nerve & Vessel Neurolysis: Meticulously dissecting and untangling the digital nerves and arteries, which are often displaced or spiraled around diseased cords, preventing numbness or vascular injury.
- Excision of Pathological Cords: Complete surgical excision of pretendinous, spiral, and retrovascular cords, releasing the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints into full extension.
- Z-Plasty Skin Lengthening: Converting contracted skin using local Z-plasties or employing the McCash open-palm technique to allow tension-free closure.
Postoperative Rehabilitation & Splinting
Commencing early active hand therapy within 3 to 5 days combined with custom nighttime extension splinting maintains straight fingers and maximizes hand dexterity.