Needle Aponeurotomy or

Percutaneous Needle Fasciotomy.

 

This is one of the most interesting developments in Dupuytrens in the last 10 years. Developed by a French Rheumatologist the technique has been excoriated by many surgeons who have taken the view that the technique by not allowing exposure and visualisation of the nerves has a high rate of nerve damage and a high recurrence rate.

This view was strengthened by the report of Dr Foucher that he saw a 60 % incidence of nerve damage . Whilst I cannot comment on his technique, this is not the conclusion of the increasing numbers of surgeons doing the technique in Europe and the States.

We find that with careful attention to detail there has been no evidence of nerve damage in our clinic so far.  Dr Werker from Zwolle in the Netherlands has reported his experience with  NA in a recent paper in the Journal of Hand Surgery.  He reported 2 patients out of 74 having numbness in their finger. In contrast Dias et al reported between 36 and 46% of patients reporting numbness after surgery.

The downside of the procedure is that recurrence is almost certainly faster than with fasciectomy.  Dr Werker found that the recurrence rate after NA for Dupuyutrens was close to 65% at 3 years.  This varies with where the disease is and probably the age of the patient.  Older patients do seem to have a lower recurrence rate than younger people.

Our view

We see needle aponeurotomy as probably the best first line treatment for dupuytrens disease available at present.  The combination of speed of treatment allied to early return to work and minimal risk of complications makes it ideal as a first stage.

If patients develop a recurrence there is nothing to stop further needle aponeurotomy being performed or standard surgery.  There is no evidence that fasciectomy is harder after needle aponeurotmy than in normal dupuytrens tissue.

How can I be considered for surgery?

The initial preoperative picture with contractures of the ring finger and mild contractures of the index and middle

 

Injecting the local anaesthetic, we use approximately 0.1ml of Lignocaine.

Using the needle to section the band in the ring finger

After the first sectioning.  There will be another two or three punctures in the ring finger to complete the process but none of the wounds will be larger than this.

The final picture.  There was some joint contracture in the ring finger which will improve with the splint.  No physiotherapy was required and the patient could return to all activities the following day.