Challenges and innovations in the surgical treatment of advanced Dupuytren disease by percutaneous needle fasciotomy: indications, limitations, and medico-legal implications

Abstract

Background: Dupuytren disease, a chronic thickening and retraction of the palmar aponeurosis of the hands, may result in permanent and progressive flexion of one or more fingers. Percutaneous needle fasciotomy is a simple method that uses a hypodermic needle usually performed under local anaesthesia. The study aim was to report the postoperative results and complications using a percutaneous approach to treat Dupuytren contracture in a consecutive series of patients with advanced Dupuytren disease, also considering the relevant medico-legal implications.

Methods: Retrospective multicentre study of all patients with Tubiana stage 3-4 Dupuytren contracture treated with percutaneous needle aponeurotomy, with no ultrasound assistance, from 2012 to 2022. Patient demographics, disease severity, treatment-related complications, and the incidence of recurrence were identified. An overview of therapeutic treatment options has accounted for 52 relevant sources spanning the 2007-2023 time period.

Results: Overall, 41.7% (N = 200) of patients were females, the mean age was 72 years (60-89), the right hand was treated in 54.2% (N = 260) of patients. The little finger was involved in 50% of the patients. The 12 months mean PED was 9°, the mean quickDASH was 8, the mean URAM 6. Minor complications were reported in 18.7% (N = 90) of patients, typically skin lacerations (83.3%) with no clinical sequelae, and no major complications were reported. Recurrence occurred in 30% (N = 144) of patients.

Conclusions: Percutaneous needle fasciotomy is safe and reliable even in patients with advanced Dupuytren disease, resulting in predictably acceptable outcome with low risk of complications.

Keywords: Dupuytren contracture surgery; Dupuytren disease; Medico-legal implications; Percutaneous needle aponeurotomy; Percutaneous needle fasciotomy.

Fig. 1

Preoperative images of Dupuytren’s disease, affecting V finger, in two different patients. A, Tubiana stage IV, B Tubiana stage III-IV

Fig. 2

Post-surgery images of the two selected patients presented in Fig. 1. A, the patient selected in Fig. 1 with A after 1 months; B, the patient selected in Fig. 1 with B after 6 months