Effectiveness of Percutaneous Needle Fasciotomy for Second or Higher Recurrence in Dupuytren Contracture
Percutaneous needle fasciotomy (PNF) has been shown to be an effective treatment for first contractures and first recurrences in Dupuytren disease (DD). The aim of this study was to investigate if PNF was an effective treatment option for second, third and fourth recurrent Dupuytren disease.
Patients and Methods
This was a retrospective medical file study on patients who underwent second (or higher) treatment for DD using PNF. Patients treated at UMCG in between 2007 and 2014 were identified using operation codes for PNF. Inclusion criterion for this study was the third, fourth or fifth treatment of the same ray. The primary outcome measurement was the reduction of total passive extension deficit (TPED) as a result of third, fourth or fifth treatment.
We found that 11 rays (11 patients) underwent PNF for a second recurrence, four rays (four patients) for a third recurrence and three rays (two patients, three hands) for a fourth recurrence. TPED reduction after a third, fourth and fifth treatment was, respectively, 73 %, 63 % and 27 %. Third and fourth treatment was just as effective as the first and second treatment. Results showed a trend towards less effective treatment at proximal interphalangeal (PIP) level than at metacarpophalangeal (MCP) level, irrespective of treatment number. By means of PNF, a more aggressive treatment was postponed in this subset of cases with an overall average of 4.5 years.
This study showed that the effectiveness of PNF for second and third recurrences was high. Treatment of fourth recurrences with PNF showed to be less successful.
KeywordsPercutaneous needle fasciotomy Effectiveness of treatment Recurrent disease Retrospective
Acknowledgements and Conflict of Interest Declaration
Photographs shown are reprinted with kind permission from: Werker, PMN and Reichert, B: Percutaneous Needle Fasciotomy. In: Dupuytren Disease, Instructional Course Book, FESSH. Ed: D. Warwick. (2015) Publisher: C.G. Edizioni Medico Scientifiche, Via Piedicavallo 14–10145 Torino
Paul M. N. Werker has participated in advisory board meetings for Pfizer Ltd and Sobi Ltd regarding the use of collagenase for Dupuytren Disease and has been a trainer for Pfizer Ltd in the use of collagenase for DD. Margot A. Vlot has no conflict of interest to declare.
- van Rijssen AL, Werker PM (2012) Percutaneous needle fasciotomy for recurrent Dupuytren Disease. J Hand Surg Am 37(9):1820–1823Google Scholar
- Werker P (2016) Comparison of the literature on PNF and CCH as minimally invasive treatment options for Dupuytren disease. In: Werker PMN, Dias J, Eaton C, Reichert B, Wach W (eds) Dupuytren Disease and Related Diseases – The Cutting Edge. Springer, Cham, pp. 151–157Google Scholar