Phoenix Hand Surgery


Dupuytren’s Contracture
J Hand Surg Br. 2003 Oct;28(5):427-31.

Percutaneous needle aponeurotomy: complications and results.


Recently French rheumatologists have repopularized fasciotomy using a percutaneous needle technique. This blind approach has been claimed to be plagued by numerous complications. We reviewed the charts of 211 patients treated consecutively on 261 hands and 311 fingers to assess the rate of postoperative complications. The first 100 patients were evaluated with a mean follow up of 3.2 years to assess the rate of recurrences and extension of the disease. In the whole group the mean age was 65 years and delay between onset and treatment was 6 years. Division of the cords were performed only in the palm in 165 cases, in the palm and finger in 111 and purely in the finger in 35. Complications were scarce without infection or tendon injury but one digital nerve was found injured during a second procedure. Postoperative gain was prominent at metacarpophalangeal joint level (79% versus 65% at interphalangeal level). The reoperation rate was 24%. In the group assessed at 3.2 years follow up, the recurrence rate was 58% and disease “activity” 69%. Fifty nine hands need further surgery. The ideal indication for this simple and reliable technique is an elderly patient with a bowing cord and predominant MP contracture.

Dupuytren’s Contracture

Also known as contracture of the palmar fascia Dupuytren’s Disease is a multifactorial disease that usually develops over many years. People affected with this condition get cords or nodules on the palm side of their hand. The cords can occur anywhere from the base of the palm all the way into the digits and all the way from the thumb side of the hand to the small finger side of the hand. Most commonly the people affected are men of Northern European descent.

Fortunately, these Dupuytren’s cords do not usually cause pain. However, as the contracture progresses patients can lose their ability to do certain things that would require them to fully open or extend their fingers. In some cases the cords can become involved with the flexor tendon sheath causing a trigger finger and this combination can bre painful and difficult to treat.

Dupuytren’s cords by themselves do not necessarily need to be treated. When the contracture progresses to the point of interfering with daily activities, most hand surgeons do recommend some treatment be initiated.

Because of the nature of Dupuytren’s contracture, there is no pill or non-procedural treatment that is very effective. In the 1700’s when this disease was first described the treatment was to take a small sharp object and to slice the cord. Unfortunately because of the proximity of the cord to underlying structures this technique resulted in an unusually high rate of complications. Eventually this technique was abandoned ad with the advent of anesthetics excision of the cord gained favor. This remains the most effective treatment for a Dupuytren’s cord.

There has been a resurgence of the original technique in which the cord is simply divided using a needle in the office. This technique is called needle aponuerotomy and can be performed in the office.
There is another version of this technique in which an enzyme is injected into the cord and chemically dissolves the cord. The injected is combined with a manual manipulation and the cord is ruptured. This enzyme is the newest treatment for Dupuytren’s contracture and is called Xiaflex.

No matter what the treatment option. any treatment of Dupuytren’s cords carries with it certain risks and when seeking treatment for Dupuytren’s contracture patients should be evaluated by a surgeon specializing in surgery of the hand to get a full understanding of the risks and benefits of each treatment as one treatment option is not right for everyone.