Needle aponeurotomy in Dupuytren's disease

Abstract

Needle aponeurotomy (NA) is recommended as a nonsurgical treatment for Dupuytren's disease. The aim of the procedure is to cut the Dupuytren's cord by use of the bevel of a needle and to restore full extension of the metacarpophalageal or proximal interphalangeal joints. According to Lermusiaux's standard, NA is performed in an outpatient setting, with the patient under local anesthesia. It entails the use of a 25-gauge, 16 mm-long needle and an anesthetic mixture of lidocaine and acetate of prednisolone. Various modifications have been proposed since the description of Lermusiaux's standard. Lermusiaux's and modified standards demonstrated structural efficacy in Dupuytren's disease. Clinical studies indicate that the mean rate of good structural results of NA is 80% at short-term assessment and 69% at 5-year assessment. Most of the studies are case series and only one is a randomized trial. Better results are demonstrated in early stages of the disease. NA also reduces disability and patients are highly satisfied. The short-term results with Lermusiaux's standard do not appear to be impaired in digital involvement. This is not the case for modified standards providing better results with palmar involvement. Lermusiaux's standard appears to provide less recurrences and less adverse events. In the largest study, skin fissure was observed in 8% of hands, transient dysesthesia in 3%, local infection in 0.7%, and flexor tendon rupture in 0.2%. Values were lower if related to NA sessions or NAs during each session. We therefore recommend Lermusiaux's standard for safe and effective NA in patients with Dupuytren's disease.