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Fasciectomy with full thickness skin graft
Fasciectomy with a full thickness skin graft is a surgical treatment for Dupuytren’s disease, generally used for more advanced or recurrent contractures. This page explains what the operation involves, what recovery looks like, and the risks and benefits to weigh up.
At a glance
Anaesthetic
General anaesthetic
Where
The Avenue Hospital
Day case or overnight
Usually day case; occasionally overnight
First post operative review
Approximately one week after surgery to check the graft, remove the plaster and have you seen by a hand therapist
Driving
Not until the hand is out of dressings, comfortable and able to grip the steering wheel, generally 4+ weeks
Post Operative Hand Therapy
Mandatory for splinting and range of movement exercises
Splinting
Yes. Two weeks of splinting of the skin grafts, and then the splint is worn, particularly at night, for a period of months after surgery to help maintain finger extension
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed initially
Return to repetitive & heavy loading
Heavier use of the hand usually from around 6 weeks, guided by wound and graft healing
Removal of Dupuytren's tissue with skin grafting
Fasciectomy with full thickness skin graft is surgery for Dupuytren’s contracture that
- removes the thickened, contracted tissue (cords and nodules) that pull the finger into the palm, and
- replaces portions of the palm or finger skin with one or more full thickness skin grafts, usually taken from the inner forearm or arm.
Dr Tomlinson recommends this surgery for individuals who have aggressive and extensive Dupuytren’s contracture, not for simple contracture.
Who is this procedure for?
- People with a significant flexion contracture that limits hand function
- People with recurrent or aggressive Dupuytren's contracture
- People whose disease is affecting the ability to fully open the hand, place it flat, or fit it into a glove or pocket
- People whose disease is not suitable for needle fasciotomy
What does the surgery involve?
Surgery involves
- incisions to the palm and fingers along the affected cord,
- carefully dissecting the thickened tissue away from the digital nerves and blood vessels (which can be displaced by the disease and are at risk during this dissection),
- removal of the thickened, contracted tissue.
- skin grafts taken from a donor site such as the inner arm or forearm
- skin grafts stitched into place on the palm or finger(s) and protected with a dressing and half plaster while it “takes”
- two weeks of immobilisation of the skin grafted areas
- considerable post operative hand therapy
Alternatives to surgery
Skin-grafting fasciectomy is one option for Dupuytren’s contracture. Depending on your situation, the alternatives may include:
- Fasciectomy without skin graft: where the skin is not significantly involved, the risk of recurrence not of high concern, and the skin can be closed directly or with local tissue rearrangement (see the separate page on this)
- Needle fasciotomy: a less invasive option for suitable cord patterns, though with an earlier and higher recurrence rate, is not able to address involved skin and is not able to address contractures where the cord is not palpable
What happens if left untreated: Dupuytren’s disease typically progresses slowly over time, and an established contracture will not resolve on its own; it usually continues to worsen, making the finger increasingly difficult to straighten.
Dr Tomlinson will discuss which options suit your specific disease pattern at your consultation.
Watch: Dupuytren's information video
What the weeks after surgery actually look like
This page sets out the procedure and the general risks. The download adds the week-by-week recovery path and the risks specific to this operation, including the less commonly discussed ones: nerve and artery injury, carpal tunnel symptoms unmasked by swelling, and the amputation risk in re-operated areas.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves. Desk-based work is often possible after 2-3 weeks. Manual work is usually deferred for longer, often 6-12 weeks to protect the graft and allow the hand to heal. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Plan not to drive for three weeks after the procedure. You may be unable to drive for longer than this, given that to be safe to drive you need to be able to grip the steering wheel firmly with both hands and take evasive action in the event of an emergency.
When can I do a full day of administrative or desk work?
Often from 2-3 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days, and improves and speeds the healing of your skin graft. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication – your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
A splint, often worn at night, is commonly used for several months after surgery to help maintain the hand and treated finger(s) in an extended position while the tissues remodel and the graft matures. You must wear a splint full time for two weeks after surgery.
Will I need to see a hand therapist afterwards?
Yes. Hand therapy plays an important role after this surgery, both to manage the skin graft and scarring, and to maximise and maintain finger straightening through supervised exercises and splinting.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Injury to a digital nerve or artery, which often lie close to the diseased tissue, particularly with recurrent disease. This can result in temporary or permanent change in sensation, or in long-term cold intolerance in that finger. This risk increases with each operation in the same area, because the earlier surgery leaves scar tissue around the digital artery and nerve that have been dissected.
- Partial or complete loss of the skin graft, requiring further dressings or, occasionally, a further graft
- Haematoma (a collection of blood) beneath the skin, sometimes requiring drainage
- Flare reaction or complex regional pain syndrome, causing increased pain, stiffness and swelling after surgery
- Hair growth on the palm if hair-bearing skin is used for the graft
- Recurrence of the disease outside the grafted area
- Post operative swelling can unmask carpal tunnel syndrome that was previously without symptoms; if this does not settle over time then surgical release of the carpal tunnel may be required.
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for at least 72 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time. You will not have the use of the hand that was operated on, as it will be wrapped up in bandages and plaster.
First week
Keep the bandages and plaster dry and intact until your post-operative review. You may use your hand as a paperweight. A sling may be useful to assist you in keeping your hand elevated and still. You'll need to wear a plastic bag or covering when showering as your hand and forearm must be kept dry.
Second week
The graft and donor site are protected with dressings and monitored closely, as the first one to two weeks are critical for the graft to establish a blood supply ("take"). Movement is guided carefully by your surgeon and hand therapist during this period.
6 weeks
Full grip strength may take several months to return, and deep-pressure tenderness over the wound can persist for some months. The scar will feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle.
Long term
The graft usually "settles in" over 6-8 weeks, though final maturation, softening and improved sensation can take up to a year. Hand therapy and night splinting typically continue for several months to help maintain the improved finger position.
Want to know more about Fasciectomy with Full Thickness Skin Graft (Dupuytren’s Surgery)?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.