Pearls and pitfalls of needle aponeurotomy in Dupuytren's disease.

BACKGROUND: Dupuytren's disease is a benign, progressive, fibroproliferative disease, and despite advances in basic science and technology, there remains no cure. To date, open fasciectomy procedures remain the criterion standard for the treatment of Dupuytren's disease despite a significant complication rate and recovery time. Needle aponeurotomy, a less invasive treatment, is associated with reduced complications and quicker recovery.

METHODS: A literature review and a compilation of over 700 procedures was performed to highlight the clinical relevance of needle aponeurotomy. A step-by-step description of the author's technique for needle aponeurotomy is presented, emphasizing the pearls and pitfalls of the procedure.

RESULTS: Recurrence rates for open fasciectomy are 5 to 10 percent per year compared with rates for needle aponeurotomy, which are 10 to 20 percent per year. Overall complication rates are much less frequent with needle aponeurotomy, with skin tears being the most common (3 percent). Needle aponeurotomy is cost effective compared with open fasciectomy. Recurrent proximal interphalangeal joint flexion contractures remain the most problematic in terms of correction.

CONCLUSIONS: Needle aponeurotomy has been shown to be an extremely useful adjunct available to the surgeon in the treatment of Dupuytren's disease. This procedure can be performed easily in an outpatient setting or office and carries with it dramatic results. Needle aponeurotomy has a lower complication rate and quicker recovery when compared with open fasciectomy and is therefore offered to patients as a first-line treatment.