Percutaneous needle aponeurotomy for Dupuytren's disease

Objective. Percutaneous transverse aponeurotomy of the cord by using a hypodermic needle as a scalpel blade in order to improve function of the hand. Indications. Symptomatic flexion contracture with positive table top test caused by a single, palpable cord within the palm (primarily Tubiana stages I and II). Contraindications. Multiple, infiltrating or broad-based cords within the palm; irritated skin conditions; exclusive digital cord localization; recurrence after aponeurectomy; previous surgical intervention at the site of interest, digital nerve lesions; lack of patient compliance. Surgical technique. Pinpoint surface anesthesia is obtained by injecting each portal area subdermally with 0.1 ml of local anesthetic. These applications start from distally to proximally within the palm while the most distal injection site is located proximal to the distal palm crease. Then the needle tip is introduced perpendicular to the cord. Sawing movements through the cord are performed transversely. While passively extending the contracted finger, the cord is held under tension which guarantees safe cutting. Patients are encouraged to report immediate pain sensation or numbness in order to prevent injuries to neurovascular structures and active finger flexion excludes tendon lesions during the procedure. Introducing the needle tip may be performed at several sites along the cord, if necessary, from distal to proximal at least 5 mm apart with prior pinpoint surface anesthesia. Finally, cautious passive stretching may be done after each release. Postoperative management. Bandaging allowing immediate motion; application of a hand-based extension splint-glove during the night for 3-6 months. Results. Recurrence rate was 53% in 15 retrospectively examined patients after a mean interval of 40 months postoperatively.