Percutaneous Needle Fasciotomy for Recurrent Dupuytren Disease

• Published in: The Journal of hand surgery (American ed.) Vol. 37; no. 9; pp. 1820 - 1823
• Main Authors: van Rijssen, Annet L., MD, PhD, Werker, Paul M.N., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2012; Elsevier
• Subjects: Aponeurotomy; Biological and medical sciences; Diseases of the osteoarticular system; Dupuytren; Dupuytren Contracture - surgery; Fasciotomy; Female; Follow-Up Studies; Humans; Juxtaarticular diseases. Extraarticular rhumatism; Male; Medical sciences; Metacarpophalangeal Joint - physiopathology; Metacarpophalangeal Joint - surgery; Middle Aged; Minimally Invasive Surgical Procedures - methods; Needles; Orthopedics; Postoperative Complications - surgery; Range of Motion, Articular - physiology; Recurrence; Reoperation; Retrospective Studies; Risk Factors; recurrence; fasciotomy; Aponeurotomy; Dupuytren; Juxtaarticular disease; Relapse; Diseases of the osteoarticular system; Fasciotomy; Percutaneous route; Disease of the hand; Orthopedics; Needle; Dupuytren contracture; Upper limb
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2012.05.022

Purpose Increasing options to treat Dupuytren disease include percutaneous needle fasciotomy (PNF), a minimally invasive technique that has proven to be effective for the treatment of primary disease. However, its effect on recurrent disease is not clear. Methods We studied 30 patients with recurrent Dupuytren disease in 40 fingers, with a mean follow-up of 4.4 years. Primary outcome measures were total passive extension deficit reduction and interval to a second recurrence, defined as an increase of more than 30° compared with the result at the end of the previous treatment. We noted complications. Results Total passive extension reduction was 76%. Percutaneous needle fasciotomy was especially effective for the metacarpophalangeal joint, with an average reduction of 93%, whereas the average reduction in the proximal interphalangeal joint was 57%. A total of 50% of patients did not develop a secondary recurrence during follow-up. The other 50% did, and we treated recurrence within an average of 1.4 years after PNF. By means of PNF, we postponed tertiary treatment an average of 2.9 years starting from the initial treatment for Dupuytren disease. We successfully treated all secondary recurrences by limited fasciectomy, according to patients' wishes. We noted no major adverse effects. Conclusions Percutaneous needle fasciotomy can be applied effectively for recurrent disease; 50% of patients remain free of recurrence for a mean of 4.4 years. If a secondary recurrence occurs, it does so relatively early after treatment. Patients must therefore be willing to accept this uncertainty in the context of the advantages of PNF, such as fast recovery, low complication rate, and minimal invasiveness. Type of study/level of evidence Therapeutic IV.