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Fasciectomy without skin graft
Fasciectomy is a surgical treatment for Dupuytren’s contracture that removes the diseased, thickened cord to straighten the finger. This page describes the process when a skin graft is not used; it 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
Day case - home the same day
First post operative review
One week after surgery
Driving
Not until the hand is comfortable out of dressings, generally 2+ weeks
Post Operative Hand Therapy
Required for splinting, range of movement exercises, scar management
Splinting
Yes - a splint is usually worn, particularly at night, for a period of months after surgery to help maintain finger extension. In the first week you will have a half plaster with bandages.
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed initially
Return to repetitive & heavy loading
Light activities after 1-2 weeks; heavier use of the hand usually from around 4-6 weeks
Removal of Dupuytren's contracture tissue with direct wound closure
Fasciectomy is surgery for Dupuytren’s contracture that removes the thickened, contracted tissue (the cords and nodules formed by the fascia) that cause the finger to bend into the palm.
When the decision is made to do so prior to surgery, the intention is to close the wound directly or with local techniques such as a zig-zag (Z-plasty) closure, without the need for a skin graft. There is always a possibility that a skin graft may be required due to skin shortage, which relates to the severity of contracture. In mild contractures direct closure is likely possible. In severe contractures it is likely not possible, and also not advisable.
Who is this procedure for?
- People with a flexion contracture affecting the MCP or PIP joint that limits hand function
- People whose skin overlying the cord is not significantly involved or tethered by the disease, allowing for direct closure
- People whose disease is affecting the ability to fully open the hand, place it flat, or fit it into a glove or pocket
- People for whom needle fasciotomy is not suitable, or who prefer not to have needle fasciotomy
- People who do not wish to have a skin graft performed as part of their surgery, and whose pattern of contracture is suitable for this
What does the surgery involve?
Surgery involves an incision, often in a zig-zag pattern, along the affected cord, carefully dissecting the diseased tissue away from the digital nerves and blood vessels (which can be displaced by the disease and are at risk during this dissection), and removing it. The skin is then stitched closed, sometimes with the zig-zag incision technique (Z-plasty) helping to redistribute tension and reduce the chance of the scar itself contracting.
Alternatives to fasciotomy without skin graft
Fasciectomy without skin graft is one option for Dupuytren’s contracture. Depending on your situation, the alternatives may include:
- Fasciectomy with skin graft: where the overlying skin is significantly involved, or for recurrent disease (see the separate page on this)
- Needle fasciotomy: a less invasive option for suitable cord patterns, though with a higher recurrence rate
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 contracture pattern at your consultation.
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 a little longer, often 6+ weeks, to protect the healing wound. 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. 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, if you’re having sedation or a general anaesthetic 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. (If your procedure is under local anaesthetic only, fasting is generally not required, but please still let us know.)
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 finger in an extended position while the tissues remodel.
Will I need to see a hand therapist afterwards?
Yes. Hand therapy plays an important role after this surgery, both to manage 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
- Haematoma or wound-healing problems, including skin loss over the wound
- Recurrence of the contracture, particularly at the middle knuckle (PIP joint)
- Stiffness or reduced finger movement
- Flare reaction or complex regional pain syndrome
- Higher complication risk if this is a repeat (revision) procedure
Anaesthetic
Your anaesthetist will discuss the specific risks of general 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
You will commence gentle range of movement exercises under the guidance of your hand therapist once the dressings are removed at your first post operative appointment.
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
Most people are back to light activities within 2 weeks and heavier use of the hand by 6-8 weeks. Hand therapy and night splinting typically continue for several months to help maintain the improved finger position.
Want to know more about Fasciectomy without Full Thickness Skin Graft (Dupuytren’s Surgery)?
Contact us to schedule an appointment with Dr Tomlinson.
How this differs from the graft-based operation
This page explains who this suits and how it’s done. The download focuses on where it diverges from fasciectomy with a graft: the skin requirement that decides whether it’s possible at all, and the slightly simpler recovery without a graft to protect.
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.