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Percutaneous Needle Aponeurotomy for Recurrent Disease Following Open Fasciectomy: Is it Safe?
Fernando A. Herrera1; Ahmed S. Suliman, MD1; Jason Roostaeian1; Kodi Azari, 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

Purpose: Dupuytren's is an unpredictable disease process  that results in contractures across multiple joints within the hand and fingers. Many surgical options exist with recurrence rates ranging from 0-70%. Revision surgery can be extremely difficult after previous open surgery.  However with the recent paradigm shift in the use of percutaneous needle aponuerotomy the safety of needle aponeurotomy after previous open fasciectomy for the treatment of recurrent disease has been called into question. The purpose of our study was to determine the safety and efficacy of percutaneous needle aponeurotomy (NA) for recurrent disease in patients with Dupuytren’s contracture following previous open fasciectomy.

Methods: Retrospective review of patients with Dupuytren's contractures treated with NA for recurrent contractures following prior open fasciectomy  . Recurrent disease was defined as the presence of a palpable cord within a previously operated field resulting in contracture of greater than 20 o at the metacarpophalangeal or proximal interphalangeal joint.  Demographics, severity of disease, preoperative and postoperative contracture, and complications were identified.

Results: Twenty nine digits in twelve patients were identified from 2009-2010. Nine patients were male. Mean age was 64 yrs of age (56-74 years). All patients had contractures at the MP and PIP. The mean preoperative total passive extension deficit (TPED)was 37o. The  mean  preoperative MP contracture was 25o, mean preoperative PIP contracture was 36o . The mean Immediate postoperative TPED was 1.4o, mean postoperative MP contracture was  0o, mean postoperative PIP was 2.5o. The mean follow up was 13 weeks (2 weeks - 12 months). Mean MP residual contracture at follow up was 3o, PIP 16o. No immediate complications occurred.

Conclusion: Percutaneous needle aponeurotomy can be safely performed in selected patients with recurrent disease following prior open surgical procedures.

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