duputren's disease update: needle aponeurotomy
TRANSCRIPT
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DUPUYTREN’S DISEASEUpdate Needle Aponeurotomy
RICHARD W. BARTH MD
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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
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Left Hand pre procedure
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Right Hand pre procedure
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Dupuytren’s DiseasePathology
Palmar fasciaEtiology
Genetic: Northern EuropeanMale: 7:1Diabetes/ anti-seizure medicationsOccupational: No evidenceTrauma
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Anatomy
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Duputren’s DiseaseTreatmentObservationConservative TreatmentSurgical TreatmentXiaflex (Collagenase)Needle Aponeurotomy
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Needle AponeurotomyOffice procedureLocal anesthesiaGenerally minimal discomfortAverage 15 to 30 minutes
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Needle Aponeurotomy
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NA post procedureLight dressing for 24 hoursResume light activities immediatelyNo heavy gripping for 1 weekNight splint for 3 months
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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
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NA Common ComplicationsNerve injury: 1-2 percentSkin tearingRecurrence
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Case Presentation Left Hand Before Immediate post
procedure
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Case Presentation Left Hand Before Immediate post
procedure
Small skin tear
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Case Presentation Left Hand Before 3 weeks
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Case Presentation Left Hand Before 3 weeks
Skin tear healed
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Case Presentation Left Hand Before 6 months
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Case Presentation Right Hand Before Immediate post
procedure
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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