Introduction:
Dupuytren's disease is a condition of the hand that affects almost 3% of the population. This condition can be treated surgically with a new procedure called a needle aponeurotomy. John Mahoney, MD, an orthopedic hand surgery specialist in Peoria, IL, answers questions about this procedure.What is Dupuytren's Disease?:
Dupuytren's disease is an inherited condition affecting the hand. It causes the tissue just under the skin on the palm side of the hand to become thickened and contracted. This tissue, the palmar fascia, normally provides strength and support for the skin. However, in Dupuytren's disease, the palmar fascia can dramatically shorten, making it impossible to straighten the fingers. The disease is most common in men of Northern European ancestry over the age of 50.When Does Dupuytren's Disease Require Treatment?:
Treatment is of Dupuytren's disease depends on the severity of symptoms. Dupuytren's nodules can be treated by cortisone injection. If Dupuytren's disease progresses to the point that the hand cannot be placed flat on a table, then surgical treatment may be an option.What is the Standard Treatment for Dupuytren's?:
The standard treatment of Dupuytren's disease is a surgical procedure called partial palmar fasciectomy. The palm and affected finger are opened through large incisions. The abnormally contracted palmar fascia is then surgically removed. Because of the wide surgical exposure, scar tissue will form in the hand and fingers. Surgery can require prolonged rehabilitation. Some patients may need to take one to two months off from work, depending on their jobs.What is a Needle Aponeurotomy?:
Needle aponeurotomy (NA) is a minimally invasive procedure used to treat Dupuytren's contracture. In NA, the surgeon uses the tip of a needle to divide the contracted palmar fascia. This is done through microscopic puncture wounds. Unlike open surgery, the hand is not widely opened, and there is minimal scar tissue formation. The procedure is performed in the doctor's office under local anesthesia. NA was first developed in France in the 1970s and was brought to the United States by Dr. Charles Eaton of Jupiter, Florida. He has advanced the procedure, treating several thousand patients since 2003.Is the Needle Aponeurotomy a Safe Procedure?:
When performed by a trained surgeon on an appropriate patient, NA is very safe. The rate of complications, such as tendon or nerve injuries, is at least five to ten times less than with traditional open surgery. There is a 5% chance of a small tear in the skin developing, which will heal with simple bandages. The risk of developing a flare reaction after NA is exceedingly rare, unlike open surgery, where it can occur up to 5% of the time.Are the Results of Needle Aponeurotomy as Good as with Traditional Surgery?:
The rate of Dupuytren's recurrence after NA is higher when compared to traditional open surgery. After open surgery, 50% of patients will have recurrence at five years. This compares to 50% recurrence after three years with NA. Dupuytren's disease will likely come back with either treatment, just slightly sooner after NA.What is the Rehab Following a Needle Aponeurotomy?:
Generally, formal hand therapy is not required after NA. Patients are asked to keep their operated hand elevated for two days after the procedure. Patients can return to light work activities immediately. Strenuous work, sports, or hobbies are not allowed for one week. Occasionally, a splint is made to be worn at night after NA.
Sources:
Eaton C, The Hand Center © 2007.
Mahoney JD, Personal Communication, Midwest Orthopaedic Center, Interviewed 11/2007.
Murphy K, "Straightening Bent Fingers, No Surgery Required" The New York Times July 24, 2007.
