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. 2016 Dec;8(3):185-186.
doi: 10.1055/s-0036-1593391. Epub 2016 Sep 23.

The "Bowstring Arch Bridge" Analogy to Guide Sequential Portal Placement during Needle Aponeurotomy in the Treatment of Dupuytren Contracture

Roshin Thomas  1
Affiliations

The "Bowstring Arch Bridge" Analogy to Guide Sequential Portal Placement during Needle Aponeurotomy in the Treatment of Dupuytren Contracture

Roshin Thomas. J Hand Microsurg. 2016 Dec.
No abstract available

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Figures

Fig. 1
Fig. 1
Components of a Bowstring Arch Bridge and a comparative anatomy of Dupuytren contracture.
Fig. 2
Fig. 2
A single portal needle aponeurotomy in the palm may not be sufficient to detension the chord distally. This could result in excessive skin tension at the single portal site on manipulating the finger into extension and thereby cause a skin tear. This could be avoided by additional portals distally so that tension is distributed at the multiple portal sites. Furthermore, portals proximal and distal to adherent zones (skin creases, adherent nodules, vertical chords) help detension the chord on both sides of the adherent region.
Fig. 3
Fig. 3
(A) Clinical photograph of Dupuytren contracture affecting the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the ring and middle fingers along with a thumb web contracture. Black “X” mark indicates the digits involved. Blue dots mark the course of the Dupuytren chords. Hash mark indicates the potential danger zone of digital nerve spiraling. (B) Full thumb web correction was achieved with a single portal. Biportal needle aponeurotomy of the ring and middle fingers resulted in full correction of the fingers with no skin tears. Portal sites marked with arrows.
See this image and copyright information in PMC

References

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