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Needle aponeurotomy / fasciotomy This procedure was developed by a group of rheumatologists in Paris, France. It has become popular in the United States with the ever increasing push for patient convenience, safety, cost control, and minimal invasive surgery. It involves a simple doctor's visit, and if appropriate can be performed in approximately 45 minutes for the average patient. Overall the process takes about one hour, and the patient can walk out of the office similar to simple dental procedures. There is no dietary restrictions before or afterhand, and the hand can be wet typically 1 to 2 days later ie shower. The hand can be used immediately for light use, and 7 days later for unrestricted use. It involves small injections of local anesthetic into the hand, and a small needle is used to gently divide the Dupuytrens cords in the palm and fingers. Gentle pulling is used to stretch or divide the tissue, usually resulting in immediate improvement in range of motion of the fingers. A simple dressing is applied to the hand, immediate motion is allowed, and the dressing is removed in most patients the next day. There are similar risks to open surgery including nerve, tendon, and arterial injury, although probably are lower. The rate of recurrence over time is probably higher in this procedure compared to open surgery, but a repeat procedure or open surgery can be done in these situations. I do not currently perform this procedure on most patients who have had prior Dupuytrens surgery on the same finger ie severe recurrent disease or revision surgery. Open surgery may be more appropriate in this situation (see below).
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These pictures are an example of the needle aponeurotomy procedure done in the office
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