duputren's disease update: needle aponeurotomy

DUPUYTREN’S DISEASEUpdate Needle Aponeurotomy

RICHARD W. BARTH MD

CASE PRESENTATION

55 year old business owner with a 10 year history of progressive contracture of both small fingers

Right SF: MP 0 degrees, PIP 70 degressLeft SF: MP 70 degrees, PIP 30 degrees

Left Hand pre procedure

Right Hand pre procedure

Dupuytren’s DiseasePathology

Palmar fasciaEtiology

Genetic: Northern EuropeanMale: 7:1Diabetes/ anti-seizure medicationsOccupational: No evidenceTrauma

Anatomy

Duputren’s DiseaseTreatmentObservationConservative TreatmentSurgical TreatmentXiaflex (Collagenase)Needle Aponeurotomy

Needle AponeurotomyOffice procedureLocal anesthesiaGenerally minimal discomfortAverage 15 to 30 minutes

Needle Aponeurotomy

NA post procedureLight dressing for 24 hoursResume light activities immediatelyNo heavy gripping for 1 weekNight splint for 3 months

ResultsRecurrence and extension NA vs. collagenase vs. surgery

Short term almost all significant improvementLong term surgery more effective at preventing

recurrenceNeedle aponeurotomy and xiaflex no definitive

data yet as to which is more effective

NA Common ComplicationsNerve injury: 1-2 percentSkin tearingRecurrence

Case Presentation Left Hand Before Immediate post

procedure

Case Presentation Left Hand Before Immediate post

procedure

Small skin tear

Case Presentation Left Hand Before 3 weeks

Case Presentation Left Hand Before 3 weeks

Skin tear healed

Case Presentation Left Hand Before 6 months

Case Presentation Right Hand Before Immediate post

procedure

Final ThoughtsPatients prefer to avoid surgeryThere is some discomfort with both

treatmentsRecurrence is common but procedure can be

repeatedThese 2 treatments options have

revolutionized how we treat Dupuytren’s disease