Until10 years ago, U.S. hand surgeons were unfamiliar with the procedure of needle aponeurotomy (NA) for the treatment of Dupuytren’s contracture. The technique was developed in Paris by Dr. Jean-Luc Lermusiaux, a rheumatologist, in the early 1950s and has been used by rheumatologists in France for the past 30 years. It was introduced to the U.S. four years ago by Charles Eaton, M.D.
How is the surgery performed?
The procedure itself is simple: The patient is given a local anesthetic, and a small hypodermic needle is used to divide and sever the contracting bands in the diseased areas of the palm and fingers to gradually straighten the digit. NA is most effective for treatment of the palm, but also can be used in some cases of finger contracture.
Not all cases of Dupuytren’s contracture can be corrected with NA, however. Before a patient is accepted for treatment, a thorough evaluation should be done at the first appointment or by a telephone interview, and submitted photographs of the hands may be studied.
What are the benefits of needle aponeurotomy over traditional surgery?
The benefits of NA over traditional surgery are multifold. Rather than removing the abnormal tissue, NA weakens and releases the contracture, avoiding the extra surgical trauma associated with resecting it, including possible skin grafts. NA is an outpatient office procedure that takes less than an hour to perform. Patients benefit from rapid healing and are able to return to normal activity after 48 hours, with no need for hand therapy. This is in stark contrast to surgical treatment, which often requires weeks of hand therapy and rehabilitation.
NA patients also require little or no pain medication afterwards. Complications that may occur from Dupuytren’s surgery are much less likely with NA, probably due to the less invasive nature of the procedure. In the event the deformity returns, which happens in about 50 percent of patients, NA can usually be repeated.
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