Partial fasciectomy for Dupuytren's disease

Anatomical orientation through palpation and marking of anatomical landmarks:

Zigzag incision from the distal interthenar crease over the distal palmar crease to the proximal phalangeal crease of the primarily affected finger (here, the little finger). Brunner's incision in the area of the proximal and middle phalanx. Additional diverging oblique incision over an accessory cord from the distal palmar crease to the proximal phalangeal crease of the ring finger.

Sharp division of the skin.

Guiding structures

• Distal palmar crease
• Proximal phalangeal crease
• Middle joint crease
• Interthenar crease
• Main and accessory cord

Remark

To prevent future scar contractures, the incision should be planned so that the scar does not lie directly over a flexion crease.

The skin and subcutaneous tissue are carefully separated from the altered aponeurosis tissue from proximal to distal. The skin should be handled as atraumatically as possible (skin hooks, small ring clamps, no forceps!) to avoid circulatory disorders.

Caution

The skin should not be thinned too much, as this can lead to skin necrosis. If the cord infiltrates the cutis, resection with skin and skin graft should be considered.

At the level of the palm, the cord is carefully dissected from the surrounding tissue, and the vascular/nerve bundles are securely identified. Transection of the cord proximally.