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Needle aponeurotomy, also known as needle aponevrotomy or percutaneous needle fasciotomy, is a minimally invasive procedure most often used to straighten fingers that have been bent by Dupuytren’s contracture. This technique uses needles to break the toughened and contracted connective tissue that is causing the finger to contract, allowing the finger to straighten normally. Needle aponeurotomy is less expensive than traditional surgery, has few complications, and can often be performed in the doctor’s office.
Dupuytren’s contracture, also called Dupuytren’s disease, is a hand deformity affecting the palmar fascia, or the tissue under the skin of the palm. The palmar fascia is a connective tissue that lies between the tendons and the skin on the palm of the hand. It provides a stable surface that normally prevents the fingers from bending too far backward under pressure and gives a gripping surface for the fingers.
In Dupuytren’s contracture, this connective tissue tightens and contracts over time, leading to the formation of knots of tissue that can pull one or more fingers into a bent position. This condition is usually not painful, although the knots of tissue in the palm of the hand are occasionally sensitive to touch. In the early stages, patients usually seek medical care for cosmetic reasons. In the later stages, treatment may be necessary to prevent the eventual loss of hand function that can cause difficulty in performing everyday activities, such as shaking hands or getting dressed.
The modern needle aponeurotomy technique was developed by the French rheumatologist Dr. Jean-Luc Lermusiaux in the early 1950s. During the procedure, patients generally lie on their back with their arm stretched out, and the doctor may place small dots on the skin with a pen in the area where the needle will be used. Patients are given a local anesthetic, and the doctor uses the tip of a small hypodermic needle to weaken, and eventually divide, the contracted fascia via a series of microscopic puncture wounds. The procedure usually takes about an hour.
Traditional surgical treatment of Dupuytren’s contracture is partial palmar fasciectomy, in which large incisions are used to open the palm and any affected fingers, and the contracted tissue is removed. This procedure can result in drawn-out rehabilitation, possible formation of scar tissue, and other surgical complications. For this reason, patients often favor the non-surgical needle aponeurotomy procedure. In some situations, however, surgery may be required, such as cases in which a chronic disorder has caused the skin to become less elastic, prior surgery has left too much scar tissue, or cases of severe contraction.
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