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Dupuytren's Disease
Updated: Oct 4 2016

Dupytrens Open Fasciectomy

Preoperative Patient Care
Operative Techniques

Preoperative Plan


Execute surgical walkthrough

  • describe the steps of the procedure verbally prior to the start of the case


Description of potential complications and steps to avoid them


Room Preparation


Surgical Instrumentation

  • loupe magnification


Room setup and Equipment

  • standard operating table
  • hand table


Patient Positioning

  • patient placed in the supine position with hand on hand table
  • place tourniquet high on the affected extremity

Palmar Incision


Mark and make incision

  • make a transverse incision in the middle of the palm
  • extend the incision to the finger when needed
  • extended incision is through a zig-zag brunner incision

Deep Dissection


Dissect through subcutaneous tissue

  • undermine the skin flaps


Identify the diseased tissue

  • carry the dissection proximally until a transition between normal and diseased fascia is identified

Excision of Diseased Tissue


Isolate the neurovascular structure

  • isolate and protect the neurovascular structures from the diseased tissue and protect
  • dissect the neuoravascular structures from the diseased cords, retract them and protect them during the entire procedure


Release the diseased tissue

  • release the diseased tissue proximally and extend the dissection distally


Isolate the diseased tissue

  • transect the pretendinous cord proximally and follow the cord distally, dividing all connections to the adjacent normal tissue
  • if present, include the diseased Septa of Legueu and Juvara and a natatory cord from the diseased NL
  • if the diseased tissue extends into the finger, follow the digital cord into the finger
  • the digital cord must be dissected carefully because of the close proximity to the neurovascular bundle
  • identify and release the distal insertion of the digital cord


Excise the dissected tissue


Wound Closure


Irrigation and hemostasis

  • copiously irrigate the wound


Closure of the palmar incision

  • keep the transverse incision open to heal by secondary intention


Closure of the extensions of the incisions

  • close any extensions of the original incision into the fingers


Dressings and immediate immobilization

  • apply nonadherent gauze to the wound and immobilize the hand in a forearm based splint with the fingers in extension
Postoperative Patient Care
Private Note

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