Partial Fasciectomy for Dupuytren's Disease

Anatomical orientation by 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 mainly affected finger (here little finger). Brunner's incision in the area of the proximal and middle phalanx. Additional diverging oblique incision over a secondary cord from the distal palmar crease to the proximal phalangeal crease of the ring finger. 

Sharp transection of the skin.

Guiding structures

• Distal palmar crease
• Proximal phalangeal crease
• Proximal interphalangeal crease
• Interthenar crease
• Main and secondary cord 

Note

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

The skin and the subcutaneous tissue are carefully dissected from proximal to distal from the altered aponeurotic tissue. The skin is treated as atraumatically as possible (skin hooks, ring forceps, no tweezers!), to avoid perfusion disorders.

Caution

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

At the level of the palm, the cord is dissected free from the surroundings and the vascular/nerve bundles are securely identified. Detachment of the cord proximally.