Percutaneous needle aponeurotomy

Abstract

Introduction. Dupuytren‘s disease is a bening, slowly progressive disorder, which affects the palmar fascia, that become tight and shortened and conduct to irreversible flexion posture of the fingers, that leads to hand deformity and impaired hand function. It can affect any of the fingers, but it most commonly affects the little finger and ring finger. It can occur in only one hand or in both hands at the same time. The most used treatment approachis surgical resection of the fibrous tissue by limited fasciectomy, but it carries a long recovery period and significant rate of complications. Percutaneous needle aponeurotomy is minimally invasive needle technique, for mild to moderate Dupuytren contractures, with perfect short term results and fast recovery period, with no loss of function and with few complications Aim of the study. To present our experience with a minimally invasive technique of percutaneous needle aponeurotomy and making recommendations about the safety and efficacy of this interventional procedure. Materials and methods. Our experience in percutaneous needle aponeurotomy was performed in the Plastic, Aesthetic Surgery and Reconstructive Microsurgery Clinic of the Emergency Medicine Institute. We treated 21 cases with Dupuytren contracture using this procedure, from 2016 to 2019 year. This treatment tend to restore hand function with minimally invasive intervention and to prevent progression, with minimum complications. Results. Men are more likely to be affected than women, and the symptoms of disease are more severe in older men. The goal of the surgery was to reduce the contracture and improve motion of the affected fingers. After percutaneous needle fasciotomy, pacients quiqly recovered hand function, returning to daily activities. In some cases, to avoid recurences, that acording to different authors are between 12%-73% and also depend on the severity of the disease, percutaneous needle fasciotomy may need to be repeated. Also is important to do regular hand exercises, in obtaining the best results. Conclusions. Percutaneous needle fasciotomy is a minimally invasive treatment option for mild to moderate Dupuytren contractures in the metacarpophalangeal and proximal interphalangeal joints, and the procedure requires limited resources. Multiple contractures can be treated during the same session and the treatment is considerably easier for the pacient and requires a minimum of rehabilitation, compared with open fasciectomy. Pacients report a greater aesthetical and moral satisfaction.