Sample Report: Dupuytren Contracture Release
Preoperative Diagnosis: Dupuytren contracture, right palm, involving the middle and ring fingers.
Postoperative Diagnosis: Dupuytren contracture, right palm, involving the middle and ring fingers.
Procedure: Palmar fasciectomy with release of the contracture around the middle and ring fingers.
Anesthesia: IV Bier block.
Indications: The patient is a 71-year-old woman who presents with a Dupuytren contracture of the right palm. This contracture has progressively involved the base of the middle and ring fingers with progressive inability to straighten the fingers, which necessitates surgical intervention.
Description of Procedure: With the patient under IV Bier block and in supine position, the right hand was prepped and draped in a sterile fashion. A Z-shaped incision was made over the hypothenar area of the right hand and carried down to the median crease in the hand. The skin flap was dissected free from the palmar fascia, and the dimpling into the skin was removed. The palmar fascia was then dissected free proximally around the transverse carpal ligament and followed distally, removing the palmar fascia intact. The thickening of the palmar ligament into the metacarpophalangeal joint of the ring and middle fingers was resected. The neurovascular bundle was identified and traced distally. Following this, tourniquet was let down after about an hour and hemostasis was maintained in the operative field. The wound was copiously irrigated with saline. A quarter-inch Penrose drain was inserted in the operative field, and the wound was closed with interrupted 5-0 nylon sutures. Pressure dressing was applied to the hand, supported with 3-inch Kling, and a volar splint was applied which was held in place with a 3-inch Ace wrap.
The patient tolerated the procedure well. Blood loss during the procedure was less than 50 cc. There was good capillary refill to the fingers following the release of the tourniquet. The patient was sent home and will be seen in the office for followup.