Dupuytren’s Contracture / Needle Aponeurotomy

ORTHOPEDICS/HAND & WRIST/DUPUYTREN’S CONTRACTURE

Dupuytren’s contracture is a disorder that affects the hand.

With Dupuytren’s contracture, the tissue just under the skin on the palm side of the hand, become thick and contracted. This tissue, known as the palmar fascia, normally provides strength and support for the skin.

With Dupuytren’s contracture, this palmar fascia can intensely shorten, making it impossible to straighten the fingers.

Historically, the only Dupuytren’s contracture therapy alternative was a major surgical practice.

Over the past decade, other less- aggressive alternatives have emerged.

One of these modern therapies is a minimally disturbing technique called a needle aponeurotomy.

Dupuytren’s contracture Therapy depends on its signs severity.

Most patients affected by Dupuytren’s contracture have either nodules that shape firm balls of scar tissue in the palm, or cords that shape tight bands that run up the the finger palm side .

Dupuytren’s nodules can be treated by cortisone injection..

A Dupuytren’s cord can be more problematic as these can start to pull the fingers downwards towards the hand palm.

Over time, if the contracture develops, patients will be unable to straighten the fingers entirely.  

Therapy

The Dupuytren’s contracture standard therapy is a surgical technique called partial palmar fasciectomy.

The palm and the affected finger are surgically opened through large incisions and the abnormally contracted palmar fascia is then removed.

Needle aponeurotomy (NA) is a minimally aggressive technique used to treat Dupuytren’s contracture.

In NA, the surgeon uses a needle tip to divide the contracted palmar fascia.

This process is done through microscopic puncture injuries.

Unlike the open surgery, the hand is not extensively opened, and there is minimal scar tissue formation.

The procedure may be performed in the doctor’s clinic under local anesthesia.

Needle Aponeurotomy (NA)

When performed by a trained surgeon on an appropriate patient, NA is very safe and operative.

The complications rate, such as tendon or nerve damages, is less than with the traditional surgery. The unique complication is a small tear in the skin, which classically will heal with simple bandages.

Generally, formal hand therapy is not recommended after NA.

Patients are requested to maintain their operated hand elevated for two days after the surgery.

Patients can get back to performing their activities immediately. Strenuous work, sports, or hobbies are not allowed for one week.

Following an NA surgery, , a bandage is sometimes required to be worn at night.