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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