Dupytrens Open Fasciectomy

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TECHNIQUE STEPS
 
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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Execute surgical walkthrough

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

2

Description of potential complications and steps to avoid them

F

Room Preparation

1

Surgical Instrumentation

  • loupe magnification

2

Room setup and Equipment

  • standard operating table
  • hand table

3

Patient Positioning

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

Palmar Incision

1

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
H

Deep Dissection

1

Dissect through subcutaneous tissue

  • undermine the skin flaps

2

Identify the diseased tissue

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

Excision of Diseased Tissue

1

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

2

Release the diseased tissue

  • release the diseased tissue proximally and extend the dissection distally

3

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

4

Excise the dissected tissue

J

Wound Closure

1

Irrigation and hemostasis

  • copiously irrigate the wound

2

Closure of the palmar incision

  • keep the transverse incision open to heal by secondary intention

3

Closure of the extensions of the incisions

  • close any extensions of the original incision into the fingers

4

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
 

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