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Percutaneous Needle Aponeurotomy for the Treatment of Dupuytren's Contracture: Early Results and Complications
Fernando A. Herrera, MD1; Jason Roostaeian, MD1; Prosper Benhaim, MD1; Scott Mitchell, MD2
1Plastic and Reconstructive Surgery, UCLA Medical Center , Los Angeles , CA, 2Division of Hand and Microsurgery, UCLA, Los Angeles , CA

Background: Many surgical options exist for the treatment of Dupuytren's disease. The purpose of our study was to identify postoperative results and complications using a percutaneous approach to treat Dupuytren's contracture in a consecutive series of patients.

Methods: A review of all patients with Dupuytren’s contracture treated with percutaneous needle aponeurotomy (NA) from 2008 to 2010 was performed. Patient demographics, digits affected, and disease severity was recorded.  Pre-operative total passive extension deficit (TPED) was calculated for each affected digit.  TPED in the immediate postoperative period and at the time of most recent follow-up was measured.  Treatment-related complications and incidence of disease recurrence were identified.  Statistical analysis was performed using paired t-test. (Statistical significance p-value <0.05).

Results: 525 digits in 193 hands were treated with NA.  140 patients were male, average age was 65 years. The average preoperative TPED was 41o, average immediate postoperative TPED was 1o (98% correction) (P<0.05).  The average TPED at 4.5 month follow up (range 1 week to 28 months) was 11 o (73% correction). Complications included triggering, infection in 3 patients, delayed flexor tendon rupture, complex regional pain syndrome and persistent numbness. Recurrence, defined as the development of contracture >20o at the MP joint or 15o at the PIP joint was observed in 62 digits.

Conclusion: Percutaneous needle aponeurotomy is an effective technique in the treatment of Dupuytren's contracture.  Near complete correction of contractures was achieved and few complications were observed. Longer follow-up is needed to determine if these short term results are maintained.

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