Treatment by Needle Aponeurotomy 

Needle Aponeurotomy (Needle Aponevrotomy or NA) is a minimally invasive treatment for Dupuytren's contracture. In contrast to surgical treatment, which requires several months of recovery, Needle Aponeurotomy allows a more rapid recovery. In most cases, it is possible to return to near normal activities without bandages within a few days of treatment.  

This technique was developed in Paris by Dr. Lermusiaux at the Hospital Laribosière. Dr. Mahoney was personally instructed on this technique by his mentor, Prosper Benhaim, M.D. The procedure is not appropriate for all patients with Dupuytren's disease. However, in appropriately selected patients, the procedure can provide excellent results. The treatment is not a cure for the disease, but can provide a patient with several years of improved hand function.

Dr. Mahoney is pleased to offer the procedure to patients with Dupuytren's disease. Very few physicians are trained to perform the procedure in the United States. A complete list is available here.   

The technique

The procedure is usually performed in the doctor's office using only local anesthetic. Dr. Mahoney usually schedules a one-hour appointment for the initial evaluation and procedure. The patient will be fully evaluated at that time, and different treatment options will be discussed. If the patient is a candidate for Needle Aponeurotomy and agrees to the procedure, it will be performed at that time.

After numbing the skin, the tip of a hypodermic needle is used to cut the contracting cords of tissue. The cord is usually divided at several points along its length. After dividing the cords, the finger is able to be straightened. A bandage is applied to the hand, but the patient is encouraged to move the fingers immediately.

Results

The procedure is relatively new to the United States, and there are not any published studies in the American literature. In general, severe contractures are more likely to have a less-perfect final result, but there still should be significant improvement. The pictures in this gallery show typical patients and results.

Complications

The Paris group that pioneered the procedure has published a article detailing their complications.  There are several important complications that may occur:

• The contracture will probably recur.  It might take several years to come back, or it may take a few months.  It is difficult to predict. 
• The recurrence might be treatable using Needle Aponeurotomy, or it might require open surgery.
• There may be a small tear or break in the skin.  This usually will heal with simple local wound care, such as band-aids and antibiotic ointment.
• There may be an injury to adjacent structures, such as the tendons or nerves.  The risk of this occurring is probably about the same as with open surgery.  The nerve or tendon might need to be surgically repaired if the injury is severe. 
• There may be a flare reaction several weeks after the procedure. This is probably less common compared to open surgery. 
• If the proximal interphalangeal joint (the knuckle in the middle of the finger) is released or if several fingers are released, you may need to be fitted with a splint to wear at night for 2-3 months to help further straighten the fingers. Dr. Mahoney will arrange to have this splint made for you.