Needle Aponeurotomy

Needle Aponeurotomy

Introduction

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Figure 1Photograph of severe untreated Dupuytren disease.
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Figure 2Photograph of mild Dupuytren disease.
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Figure 3Photograph of complete correction of mild Dupuytren disease with needle aponeurotomy (NA).

Patient Selection

Indications

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Figure 4Photographs showing that the area of maximum bowstringing is the best location for needle aponeurotomy (NA) portals. A, Before. B, After.

Contraindications

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Figure 5Photograph shows that needle aponeurotomy (NA) can be performed as long as a palpable cord is present and the contracture is not just due to scar.
  • Contracted skin, skin grafts, and scar tissue from prior fasciectomy (Figure 5)
  • Contractures secondary to spasticity or ulnar nerve palsy

Surgical Anatomy

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Figure 6Illustration of anatomy of pathologic cords. 0 = central cord; 1 = pre­tendinous cord; 2 = distal commissural cord; 3 = abductor digiti minimi cord; 4 = lateral cord; 5 = natatory cord; 6 = proximal commissural cord; 7 = retrovascular cord; 8 = spiral cord; 9 = thumb pretendinous cord.
(Redrawn from an illustration provided courtesy of Charles Eaton, MD.)

Preoperative Imaging

Procedure

Room Setup/Patient Positioning

  • Performed usually in outpatient treatment room under local anesthesia
  • For patients with low pain tolerance, sedation can be used in surgery center or hospital setting; patient must remain responsive to stimuli and communication
  • Recumbent or sitting position
  • No tourniquet
  • No prophylactic antibiotics

Special Instruments/Equipment

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Figure 7Photograph of a short 25-­gauge, 16-­mm (5/8-­inch) needle with which needle aponeurotomy is performed.

Surgical Technique

Video 50.1 Treatment of Dupuytren Disease With Needle Aponeurotomy. Gary M. Pess, MD (2 min 30 s)
Video 50.2 Treatment of Dupuytren Disease of PIP Joint With Needle Aponeurotomy. Gary M. Pess, MD (2 min 25 s)

Preoperative Planning

May 13, 2023 | Posted by in Uncategorized | Comments Off on Needle Aponeurotomy

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