What is Needle Aponeurotomy for Dupuytren’s Contracture?
Needle aponeurotomy (NA) is a minimally invasive procedure used to treat Dupuytren’s Contracture, a progressive condition characterized by fibrous thickening and shortening of the palmar fascia. This technique involves the percutaneous division of diseased fascial bands using a needle, allowing for improved finger extension without the need for extensive surgical intervention.
Indications of Needle Aponeurotomy for Dupuytren’s Contracture
Needle aponeurotomy is indicated in individuals having:
- Early to moderate Dupuytren’s contracture (flexion deformity of 20–40 degrees).
- Functional impairment affecting daily activities.
- Preference for a less invasive alternative to open fasciectomy.
- No contraindications such as severe skin involvement or neurovascular compromise.
Procedure of Needle Aponeurotomy for Dupuytren’s Contracture
Needle aponeurotomy for Dupuytren’s Contracture procedure includes:
- Preoperative Assessment: Clinical examination and measurement of contracture severity. Consideration of adjunct imaging such as ultrasound if needed.
- Anesthesia: Local anesthetic is administered for your comfort.
- Needle Fasciotomy: A fine needle (e.g., 25G or 27G) is inserted percutaneously at multiple points along the fibrous cord. The needle is used to sever the cord through controlled movements. Gentle passive extension of the affected finger is performed to release the contracture.
- Postoperative Care: A light dressing is applied; no sutures are required. Immediate finger mobilization is encouraged. Splinting may be advised at night for a few weeks.
Advantages of Needle Aponeurotomy for Dupuytren’s Contracture
Advantages of needle aponeurotomy for Dupuytren’s Contracture include:
- Minimally Invasive: Performed in an outpatient setting with minimal tissue disruption.
- Rapid Recovery: You can resume daily activities quickly.
- Low Risk of Complications: This has reduced likelihood of infection and scarring compared to open surgery.
- Repeatable Procedure: This can be performed again if contracture recurs.
Potential Risks and Complications of Needle Aponeurotomy for Dupuytren’s Contracture
Risks of needle aponeurotomy for Dupuytren’s Contracture include:
- Recurrence: Higher recurrence rate compared to open fasciectomy.
- Skin Tears or Bruising: Due to forceful extension post-release.
- Nerve or Vessel Injury: Rare but possible, particularly in advanced cases.
Rehabilitation and Outcomes of Needle Aponeurotomy for Dupuytren’s Contracture
Post operative care for needle aponeurotomy for Dupuytren’s Contracture includes:
- Hand Therapy: Gentle stretching and strengthening exercises improve long-term results.
- Functional Improvement: Most people experience significant correction of contracture and enhanced hand function.
- Follow-up: Regular monitoring for recurrence and consideration of further intervention if needed.
