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Risks with Dermofasciectomy

The specific risks and complications associated with a dermofasciectomy include the following:

    1. Nerve damage - because of the diffuse nature of the fibrous tissue it can be difficult sometimes to trace the digital nerves and blood vessels along the finger. If the nerve is cut it can be repaired but there will be an inevitable loss of sensation to the tip of the finger which can take many months to recover and occasionally never.
    2. Blood vessel damage - see above. If the finger has been bent for a long time then it may not be possible to fully straighten it, without compromising the blood supply. I have to be careful that I do not stretch the blood vessels too much otherwise there is a risk of damaging them, leading to gangrene.
    3. Stiffness - If the first finger joint (the proximal phalangeal joint) is bent for a long time at over 75 degrees, then it may be difficult to fully straighten it and even if I do achieve it, there is a risk the joint may be stiff afterwards. This usually resolves with physiotherapy but not always.
    4. Complex regional pain syndrome - In the past this condition was known as reflex sympathetic dystrophy. This is a strange condition that can occur after any insult, whether traumatic or surgical. There is an excellent article on the subject from the National Institute of Neurological Disorders and Stroke at the following link. If the condition is recognised early then it may be possible to avoid some of the more serious symptoms. It is critical that you keep the first few post-operative reviews both with the Hand Therapist and myself, so that we can keep an eye on this possible complication. In my personal practice it occurs in less than 5% of patients.
    5. Infection - There is an incresed risk of infection with a grafting procedure. You can help reduce this by keeping the arm elevated and using the hand as little as possible in the first week. Signs of infection include pain out of proportion to that expected and a foul smell. If it occurs it can be treated with antibiotics thoough it may result in some loss of the graft. In my practice it is extremely rare.