Needle and Incisional Aponeurotomy

Jeffrey Wint

For Dupuytren's disease, The Hand Center of Western Massachusetts is one of the few places in the region where needle and incisional aponeurotomy and incisional fasciotomy for Dupuytren's disease is being performed. While not all patients are candidates for needle aponeurotomy, there are many patients who may benefit from this technique. The surgeon essentially releases the pathologic cords through a number of small puncture wounds thereby avoiding larger skin incisions more typical of the "open" procedure. In addition to avoiding more extensive skin incisions the need for formal surgery, extensive healing time and postoperative rehabilitative course is also avoided. For many patients undergoing this procedure, this reduces the immediate problem of using the hand more fully in the early post operative period. It does not mean that there will be absolutely no discomfort, but many patients feel less initial pain. One must also realize that there are many people who undergo so called regular "open" Dupuytren's fascial excision who ultimately experience similar good results after several months. It is also felt that an open procedure carries a lesser risk of recurrence over a number of years. However, those patients who undergo needle aponeurotomy, on average, have less palmar discomfort and greater functionality sooner than their "open" surgery counterparts. These benefits are measured often in days to weeks rather than weeks to months.

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