Tuesday, June 21, 2011

Needle Aponeurotomy Articles

Needle Aponeurotomy Articles
 
These review articles discuss early results of 
Needle Aponeurotomy for Duypuytren’s Disease
Percutaneous needle aponeurotomy: complications and results G. Foucher, J. Medina and R. Navarro From SOS main Strasbourg, clinique du Parc, 4, boulevard du Président Edwards, 67000 Strasbourg, France Available online 27 August 2003. Abstract 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. Chirurgie de la main 2001;20:206–211 © 2001 Editions scientifiques et medicales Elsevier SAS. Copyrights S1297-3202(01)0035-X/FLA. Corresponding Author Contact InformationCorresponding author. Dr G. Foucher, SOS main Strasbourg, clinique du Parc, 4, boulevard du Président Edwards, 67000 Strasbourg, France. Tel.: +33-3-88-35-4500; Fax: +33-3-88-24-0707; E-mail: ifssh@aol.com *1 Translated from Chirurgie de la main 2001:20:206–11 © 2001 Editions scientifiques et médicales Elsevier SAS. Copyright S1297-3202(01)00035-X/FLA. Copyright © 2006 American Society for Surgery of the Hand Published by Elsevier Inc. Dupuytren’s disease A Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren’s Disease: A 6-Week Follow-Up Study Annet L. van Rijssen MD, Feike S.J. Gerbrandy MD, Hein Ter Linden MD, Helen Klip PhD and Paul M.N. Werker MD, PhDCorresponding Author Contact Information, E-mail The Corresponding Author Department of Plastic, Reconstructive, and Hand Surgery, Isala Clinics, Zwolle, the Netherlands Received 19 August 2005; accepted 15 February 2006. Available online 19 May 2006. Purpose The demand for percutaneous needle fasciotomy (PNF) as treatment for Dupuytren’s disease is increasing because of its limited invasiveness, good outcome, limited number of complications, quick recovery, and overall patient satisfaction. This randomized controlled trial was designed to test whether these short-term expectations are sound by comparing this treatment with limited fasciectomy (LF) with regard to these aspects. Methods We treated 166 rays: 88 by PNF and 78 by LF. Total passive extension deficit (TPED) improvement at 1 week and at 6 weeks were the primary outcome parameters; patient satisfaction, hand-function recovery, and complication rate were secondary outcome parameters. We used the Disabilities of the Arm, Shoulder, and Hand questionnaire to measure disabilities of the upper extremity before and after treatment and all adverse effects and complications were recorded. Results Overall TPED improvement was best at 6 weeks. In the PNF group TPED improved by 63% versus 79% in the LF group; this difference was statistically significant. Results at the proximal interphalangeal joint were worse than those at the metacarpophalangeal and distal interphalangeal joints for both the PNF and LF groups. The rays classified before surgery as Tubiana stages I and II showed no difference between these treatments, but for rays higher than stage II LF clearly was superior to PNF as a treatment modality. The rate of major complications in the LF group was 5% versus 0% in the PNF group. Patient satisfaction was almost equal but direct hand function after treatment was considered better in the PNF group, as was the degree of discomfort that patients experienced. This was underscored by the Disabilities of the Arm, Shoulder, and Hand scores in the PNF group, which were significantly lower than those in the LF group at all time points measured. Conclusions In the short term and in cases with a TPED of 90° or less PNF is a good treatment alternative to LF for treatment of Dupuytren’s disease. Type of study/level of evidence Therapeutic, Level I. Key words: Complications; Dupuytren; needle fasciotomy; limited fasciectomy; outcomeshapeimage_2_link_0
Dupuytrens  disesase information from the Hand Center of WMA
Needle Aponeurotomy web hand out information for patientsshapeimage_3_link_0shapeimage_3_link_1shapeimage_3_link_2
 
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