Download PDF
J Hand Microsurg 2017; 09(03): 115-119
DOI: 10.1055/s-0037-1605387
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Safety and Effectiveness of Percutaneous Needle Fasciotomy for Dupuytren's Disease in the Palm

Muhammad Mansha
1   Department of Orthopaedics, The James Cook University Hospital, Middlesbrough, United Kingdom
,
Darren Flynn
2   Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, United Kingdom
,
John Stothard
3   Department of Orthopaedics, University of Teesside, Middlesbrough, United Kingdom
› Author Affiliations
Further Information

Publication History

02 April 2017

12 July 2017

Publication Date:
08 August 2017 (online)

    Permissions and Reprints

Abstract

Purpose Percutaneous needle fasciotomy is performed in the authors' department to treat Dupuytren's contracture at metacarpophalangeal joints. This study aimed to establish its safety and efficacy, compared with standard fasciectomy.

Materials and Methods All patients who had this procedure performed over the study period were sent the validated British Society for Surgery of the Hand (BSSH) postal questionnaire assessing surgical outcome. Hand function and disability were assessed using the Patient Evaluation Measure (PEM).

Results Statistically significant improvement was achieved in Dupuytren's contracture at the mean follow-up of 15 months (SD +/− 10). Approximately 97% of the fingers fully corrected at surgery remain straight. Recurrence rate was 2.2% among fully corrected fingers. However, 2 (40%) out of 5 partially corrected fingers had recurrence. No complication of any kind was noted and no antibiotics used. Hand function was measured using PEM score correlated well with the residual contracture.

Conclusion Percutaneous needle fasciotomy is safe, effective, has very low complication rates, and yields comparable results to standard fasciectomy.

Keywords

Dupuytren's disease - fasciotomy - percutaneous needle fasciotomy - surgical treatment
 

  • References

  • 1 Bayat A, McGrouther DA. Management of Dupuytren's disease—clear advice for an elusive condition. Ann R Coll Surg Engl 2006; 88 (01) 3-8
    PubMedGoogle Scholar
  • 2 Bryan AS, Ghorbal MS. The long-term results of closed palmar fasciotomy in the management of Dupuytren's contracture. J Hand Surg [Br] 1988; 13 (03) 254-256
    PubMedGoogle Scholar
  • 3 Foucher G, Medina J, Navarro R. Percutaneous needle aponeurotomy: complications and results. J Hand Surg [Br] 2003; 28 (05) 427-431
    PubMedGoogle Scholar
  • 4 Rowley DI, Couch M, Chesney RB, Norris SH. Assessment of percutaneous fasciotomy in the management of Dupuytren's contracture. J Hand Surg [Br] 1984; 9 (02) 163-164
    CrossrefPubMedGoogle Scholar
  • 5 van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM. A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study. J Hand Surg Am 2006; 31 (05) 717-725
    CrossrefPubMedGoogle Scholar
  • 6 Pess GM, Pess RM, Pess RA. Results of needle aponeurotomy for Dupuytren contracture in over 1,000 fingers. J Hand Surg Am 2012; 37 (04) 651-656
    CrossrefPubMedGoogle Scholar
  • 7 Webb JA, Stothard J. Cost minimisation using clinic-based treatment for common hand conditions—a prospective economic analysis. Ann R Coll Surg Engl 2009; 91 (02) 135-139
    CrossrefPubMedGoogle Scholar
  • 8 Dias JJ, Braybrooke J. Dupuytren's contracture: an audit of the outcomes of surgery. J Hand Surg [Br] 2006; 31 (05) 514-521
    CrossrefPubMedGoogle Scholar
  • 9 Macey AC, Burke FD, Abbott K. , et al; British Society for Surgery of the Hand. Outcomes of hand surgery. J Hand Surg [Br] 1995; 20 (06) 841-855
    PubMedGoogle Scholar
  • 10 Dias JJ, Bhowal B, Wildin CJ, Thompson JR. Assessing the outcome of disorders of the hand. Is the patient evaluation measure reliable, valid, responsive and without bias?. J Bone Joint Surg Br 2001; 83 (02) 235-240
    PubMedGoogle Scholar
  • 11 Dias JJ, Rajan RA, Thompson JR. Which questionnaire is best? The reliability, validity and ease of use of the Patient Evaluation Measure, the Disabilities of the Arm, Shoulder and Hand and the Michigan Hand Outcome Measure. J Hand Surg Eur Vol 2008; 33 (01) 9-17
    CrossrefPubMedGoogle Scholar
  • 12 van Rijssen AL, Werker PM. Percutaneous needle fasciotomy in Dupuytren's disease. J Hand Surg [Br] 2006; 31 (05) 498-501
    CrossrefPubMedGoogle Scholar
  • 13 Badois FJ, Lermusiaux JL, Massé C, Kuntz D. [Non-surgical treatment of Dupuytren disease using needle fasciotomy] [in French]. Rev Rhum Ed Fr 1993; 60 (11) 808-813
    PubMedGoogle Scholar
  • 14 Leclerq C. Complications du traitment medical de la maladie de Dupuytren. In: Simon L, Revel M, Rodineau B. , eds. Main et Medicine Orthopedique. Paris, France: Masson; 1997: 152-158
    Google Scholar
  • 15 National Institute for Health and Clinical Excellence. Needle Fasciotomy for Dupuytren's Disease, Guidance. London, UK: NICE; 2004 . Available at https://www.nice.org.uk/guidance/IPG43
    PubMedGoogle Scholar
  • 16 Symes T, Stothard J. Two significant complications following percutaneous needle fasciotomy in a patient on anticoagulants. J Hand Surg [Br] 2006; 31 (06) 606-607
    CrossrefPubMedGoogle Scholar
  • 17 Mäkelä EA, Jaroma H, Harju A, Anttila S, Vainio J. Dupuytren's contracture: the long-term results after day surgery. J Hand Surg [Br] 1991; 16 (03) 272-274
    PubMedGoogle Scholar
  • 18 Honner R, Lamb DW, James JI. Dupuytren's contracture. Long term results after fasciectomy. J Bone Joint Surg Br 1971; 53 (02) 240-246
    PubMedGoogle Scholar
  • 19 McFarlane RM, Jamieson WG. Dupuytren's contracture. The management of one hundred patients. J Bone Joint Surg Am 1966; 48 (06) 1095-1105
    CrossrefPubMedGoogle Scholar
  • 20 Sennwald GR. Fasciectomy for treatment of Dupuytren's disease and early complications. J Hand Surg Am 1990; 15 (05) 755-761
    CrossrefPubMedGoogle Scholar