Percutaneous Fasciotomy for the Treatment of Dupuytren's Disease—A Systematic Review

Abstract

Background Dupuytren's disease is described as a thickening of the palmar fascia. It typically affects men of Northern European descent in their fifties. The disease process starts as a nodule at the distal palmar crease that progressively gives rise to a cord invading distally toward the finger. Historically, different treatments have been described. Our purpose was to perform a meta-analysis of the evidence published on the percutaneous fasciotomy (PCF) treatment. Methods We searched Medline, PubMed, and the Cochrane Library for articles evalu ating the use of PCF for Dupuytren's disease. No study was excluded based on quality. Results The search yielded nine studies. Because of their different methodologies, a meta-analysis could not be performed. However, we were able to extract common qualitative conclusions. PCF is an effective treatment modality for patients in whom general anesthesia is contraindicated, with a good outcome especially at the metacarpophalangeal joint, a low recurrence rate in the short term, and few complications. Conclusions Similar conclusions were reached by all the articles under study. Nevertheless, there remains the need for a prospective study with a higher statistical power and standardized clinical evaluation and surgical methods in order to achieve more objective quantitative results. It would also be pertinent to compare the outcomes and complication rates of PCF with the new collagenase treatment.

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

“…Salhi et al's review 99 focused on the effects of PNF for the treatment of Dupuytren's disease. The authors included eight cohort studies and one randomised trial.…”

Evidence-Based Medicine

“…Recent review articles reflect both a greater focus on genetics and 1,2 molecular biology [3][4][5][6] and an openness to alternative treatments. [7][8][9][10] …”

“…The terms percutaneous needle fasciotomy or needle aponeurotomy have been used to describe percutaneous discrete transverse full-thickness fasciotomy at one or more levels. 9 In contrast, Hovius et al define "extensive percutaneous aponeurotomy" as a large number of perforations through skin, vertical septal fibers, and 1 to 2 mm into the surface of the cord: tens or hundreds of perforations may be used for each cord. The many cuts into the surface of the fascia disrupt its longitudinal structural integrity, allowing the fascia to lengthen under tension.…”

Overview of the pathogenesis, diagnosis and treatment of Dupuytren's disease

“…Several reviews and studies have been published that elaborate on surgical approaches [4,[27][28][29]. Common surgical procedures include open fasciectomy, percutaneous needle fasciotomy or needle aponeurotomy, and dermofasciectomy [7,22].…”