Needle Aponeurotomy for Dupuytren's Contracture

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.

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.

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.

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.

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.

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.

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.

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.