Needle Aponeurotomy for Dupuytren's Disease
Until recently, U.S. orthopaedic surgeons were unfamiliar with the procedure of needle aponeurotomy (NA) for the treatment of contracted Dupuytren’s cords in the hand. During NA, the surgeon uses a small hypodermic needle to divide and sever the contracting bands in the diseased areas of the palm and fingers. 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., who currently trains hand surgeons on the technique.
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. 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 should be studied.
The benefits of NA over traditional surgery are manifold. 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 physical 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 appear to be much less likely with NA, probably due to the less traumatic nature of the procedure. In the event the disease returns, which happens in about 50 percent of patients, NA can be repeated many times, if necessary.
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