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Open Palm Technique (from McCash, 1964)

- Discussion:
    - favored for advanced disease, especially in diabetics, and is indicated for patients w/ multiple involvement;
    - use transverse incisions in the palm at the distal palmar crease, as well as  transverse incisions at the base of fingers, and at PIP crease;
    - limited fasciectomy is performed;
    - when contractures are corrected, a gap of 3-4 cm may be present;
    - phalangeal incisions are closed, palmar incisions are left open;
    - either the palmar or digital wound, or both, may be left open, and in 4-6 weeks will heal into a fine linear scar;
           - twice as many complications are seen in wounds closed primarily;
    - open palmar wound does not heal simply by granulation, but by flattening of the transverse skin wrinkles;
    - advantage of this is that early motion may be started & hematoma formation, pain, edema of hand, and joint stiffness are avoided in most 

- Post Op:
      - postoperative extension splinting is mandatory;
      - only disadvantage in this technique is extra 2-3 weeks that are needed for complete healing to occur 

The open palm technique in Dupuytren's contracture.