Needle Fasciotomy

Summary

This operation is performed for Dupuytren’s disease.  The aim of the operation is to divide the abnormally thickened tissue in the palm. This leads to a straighter finger and an improvement in function.  

Factors to Consider

Symptoms from Dupuytren’s disease vary significantly between patients.  Many people will find that the position of the finger gets in the way during day to day tasks.  Without treatment the bend will typically get worse, though the timescale can be very variable. The severity of your symptoms will dictate whether you should proceed to surgery.

Non-surgical treatments such stretching and splints are typically not effective. There are a number of surgcial options which are suitable in different situations. These include needle fasciotomy, collagenase (Xiapex) injection and fasciectomy . Your surgeon will be able to discuss which of these are the most appropriate.  

Needle fasciotomy is suitable in some circumstances and depends on the pattern of your Dupuytren’s disease. It is a simpler procedure than fasciectomy as it is done under local anaesthetic, but has a higer recurrence rate.

Description of Surgery

The operation is usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital. You will need to remove any rings and jewelery from the hand and ideally false nails / nail varnish.

The operation is performed using a needle in the palm with a very small incision.  The surgeon will identify the abnormal tissue and divide it. Stitches are not needed.  The operation itself takes about 10 minutes.

Anaesthetic

The operation is usually performed under a local anaesthetic and so you will be able to eat and drink as normal.  

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The risk of infection is very small and is thought to be less than 1%.  Most infections will settle simply with antibiotics.

Damage to nerves and blood vessels and tendons to the finger can occur, though the risk of them being divided is about 1% or less.

The finger position is usually improved, though it may not go fully straight. There is a chance it may not improve, but further surgery is not compromised by trying this approach.

A skin tear can develop as the finger is straightened though this typically heals rapdily. This is more common if the skin is adherent to the abnormal tissue.

Some stiffness and swelling is common and usually resolves rapidly with elevation and movement of the fingers. Complex regional pain syndrome is a rare complication that may cause more prolonged pain, stiffness or swelling.

There is no cure for Dupuytren’s disease and it will often recur over a number of years. Rarely this can be more rapid.

After Surgery

Pain

The local anaesthetic lasts for several hours after the operation and simple painkillers are usually all that is needed after this. It is important that you take regular pain relief at first so that you can keep your fingers moving.  

Dressings

A simple dressing is usually all that is needed.

You may be given a sling to help keep the hand up whilst walking about. This helps reduce swelling, but you can come out of it to move the shoulder and elbow.

Physiotherapy

The hand is then free to move straight away and the therapist will see you to see if you need any help to mobilise the hand.

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road.  This will vary between patients but normally will be within a week.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a couple of days of your surgery.  If you have a heavy manual job it can take longer before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Your finger should be improved straight away, though it may take a few weeks before it feels back to normal.