What is needle aponeurotomy for dupuytren's contracture?

Needle aponeurotomy (say "ap-uh-noo-RAH-tuh-mee") is a procedure used to straighten bent fingers (contracture) caused by Dupuytren's disease. This procedure may also be called percutaneous needle fasciotomy.

The procedure can be done in your doctor's office. It usually takes about 30 minutes.

The affected hand will be cleaned and injected with medicine to numb the area. When it is numb, the doctor will insert a needle into the tissue that is pulling your fingers toward your palm. The needle is used to make holes in the tissue. The doctor will then straighten your fingers. This will separate the tissue and release the pull on your fingers.

After the procedure, your doctor may inject steroid medicine into your hand to reduce swelling.

Dupuytren's disease causes tissue under the skin of the palm of your hand, called the palmar fascia, to get thicker and shorter. This can pull and bend the fingers in toward the palm. Needle aponeurotomy is done to release the tight tissue in the hands and improve the use of the hands.

Needle aponeurotomy is an alternative to hand surgery, which is called fasciectomy. For this surgery, the palm is cut open and the tight tissue is removed. Compared to surgery, needle aponeurotomy:

• Is less invasive.
• Has a shorter recovery time.
• Has fewer risks.
• Costs less.

But the chance that a contracture will come back is higher and occurs sooner after needle aponeurotomy than after surgery.

This procedure may be a good option if you:

• Have a mild to moderate contracture. It may not work as well for severe contractures.
• Are an older adult or can't have open surgery because of other health problems.
• Need a quick recovery and can accept that the problem may come back.

Your fingers may not be completely straight after this procedure. But most people are able to use their hand better and are happy with the results. You can have the procedure again if the contracture comes back.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• You may need to shower or bathe with a special soap the night before and the morning of your procedure. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after the procedure.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• You may shower and your hand may get wet. But don't go swimming, use a hot tub, or put your hand underwater for 2 days.
• You can use your hand for light activity such as eating and dressing.
• Don't use your hand for 1 to 2 weeks for any activity where you need a lot of hand strength or a strong grip. This includes using power or gardening tools and riding a bike or golfing.

Bandage care

• You may have several bandages on your hand and a larger bandage covering these. Your doctor will tell you how to take care of this.

Exercise

• Gently bend and straighten your fingers throughout the day to keep them flexible and to help reduce swelling.
• If your doctor suggested hand therapy, do it as directed by your doctor or your physical or occupational therapist. This can help you regain flexibility and strength in your hand and fingers. To get the best results, you need to do the exercises correctly and as often and as long as your doctor or therapist tells you to.

Ice and elevation

• Prop up the sore hand on a pillow when you ice it or anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.

Medicine

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.

Other instructions

• If you have a splint, follow your doctor's directions for wearing it.