Fasciectomy: Unsafe at any Speed?

Fasciectomy, invented by Goyrand just a few years after Dupuytren's initial demonstration of open fasciotomy, has been the main treatment option for Dupuytren's for nearly 200 years. There have been many refinements, but the central theme of removing fascia is unchanged. With so much time and experience, one might assume that all of the wrinkles had been ironed out. Not so. Fasciectomy has inherent, unavoidable dangers even in experienced hands because of both technical difficulty and biologic reaction. In this recent report, "Surgical Complications Associated With Fasciectomy for Dupuytren's Disease: A 20-Year Review of the English Literature" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2010_Denkler.pdf), the numbers are notable. On the average, one out of six fasciectomy patients experience a major complication; more if the procedure is for recurrent disease; even more if one asks the patients rather than the surgeons. This risk is hard to justify for the treatment of a benign condition. We need better treatment options to straighten out bent fingers, but also to prevent contractures from progressing or recurring.