Needle Aponeurotomy for Stage IV Dupuytren Contracture: A Wide-Awake First Step Approach in 204 Consecutive Rays.

SUMMARY: Severe forms of Dupuytren disease are difficult to treat. Surgical fasciectomy is often the first choice, despite its high complication rate. At times, amputation is recommended. The authors evaluated the efficacy of minimally invasive needle fasciotomy (needle aponeurotomy) as the first and only treatment for severe (stage IV) Dupuytren contracture using a retrospective chart review of a single surgeon's consecutive experience over 8 years. A total of 204 rays from 165 patients with severe Dupuytren disease with total passive extension digit contracture of 135 degrees or greater were included in the study. Mean follow-up was 22.3 months. Standard goniometric measurements of finger joint contractures were taken before needle aponeurotomy and at follow-up visits. Total passive extension digit and flexion contracture improved significantly at each finger joint. Before the procedure, median flexion contractures were as follows: at the metacarpophalangeal joint, -70 degrees (interquartile range, -80 to -55); at the proximal interphalangeal joint, -75 degrees (interquartile range, -85 to -65); and at the distal interphalangeal joint, -5 degrees (interquartile range, -20 to 0); median total passive extension of digit was -145 degrees (interquartile range, -160 to -135). Flexion contractures after the procedure improved with 74 percent gain at the metacarpophalangeal joint, 32 percent gain at the proximal interphalangeal joint, and 46 percent gain at the distal interphalangeal joint, with 55 percent gain of total passive digit extension overall ( p < 0.001). The study shows that needle aponeurotomy led to significant improvements in joint contractures at all finger joints with minimal adverse effects. Needle aponeurotomy is an effective and safe first-line treatment for severe Dupuytren disease as the sole treatment or as a preliminary step for more invasive procedures if needed.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.