Versatility of percutaneous needle fasciotomy for Dupuytren's disease across a spectrum of disease severity: A single-surgeon experience of 118 rays

Abstract

Background Percutaneous needle fasciotomy (PNF) represents the only minimally invasive approach for treatment of Dupuytren's disease in Europe since withdrawal of collagenase from European markets. Though well-established, surgeon preference and uncertainty regarding safety and efficacy, results in limited provision in favour of open fasciectomy. Methods A retrospective review of 74 patients who self-opted to receive PNF between 2017 and 2020 was conducted. Demographic data, complications and degree of release achieved were compared across three cohorts based on contracture severity as per Tubiana staging (TS): Stage 1, 0–45°; Stage 2, 46–90°; Stage 3, 91–130° with χ 2 analysis. Results One hundred and eighteen rays were treated amongst 74 patients (mean age, 68 years (R, 32–86), males: 74%) with mean follow-up 51 weeks (IQR 28–76 weeks) with no significant difference in baseline characteristics across cohorts. No cases of permanent sensory disturbance, flexor tendon rupture, arterial transection nor infection were observed. Neuropraxia was seen in six patients, resolving with mean recovery of 6 weeks. 86% ( n = 166) of joints had satisfactory release (residual passive extension deficit (PED) ≤10°) with full release in 67%. Full release was most likely in metacarpophalangeal joint (MCPJ; 93%) than distal interphalangeal joint (DIPJ; 67%) or proximal interphalangeal joint (PIPJ; 45%; p <0.0001). Mean release was 54° in MCPJ and 56° in PIPJ. All TS1 patients achieved release with ≤10° residual PED versus 75% of TS2 patients and 22% of TS3 patients ( p <0.05), the latter of whom had a mean residual PED of 12° Ninety-two percent of patients stated they would undergo PNF again if necessary, in preference to open fasciectomy. Conclusion We find PNF to facilitate a safe, effective yet minimally invasive approach amongst patients of varying disease severity, across different age groups, with recurrent disease, associated comorbidities or concurrent anticoagulation therapy. Patients reported high satisfaction in preference to open procedures. We, therefore, intend to recommend PNF first-line to all patients regardless of disease severity.

Reply to letter regarding “Percutaneous needle fasciotomy for Dupuytren's disease: A one-stop approach incidentally suited to the era of COVID-19”

“…However, we find that the technique can be used successfully in both proximal and distal interphalangeal joints. In our recently published series of PNF in 118 rays 3 , mean contracture release was not significantly dissimilar when undertaken in the proximal or distal interphalangeal joints in comparison to the metacarpophalangeal joint. Indeed, clinically satisfactory release of the PIPJ was achieved in 79% of cases with no major complications observed including no incidence of permanent sensory disturbance.…”

Clinical and morphological outcomes after percutaneous needle fasciotomy in Dupuytren’s disease according to the contracture severity

“…In 2021, Patel & Patel offered further evidence on the usefulness of this approach. Their study shows satisfactory release (≤10° residual PED) in 87% of all treated joints, without major complications [ 15 ]. The present study reports good results as 90% of studied patients at one-year follow-up present satisfactory release.…”

“…Badois et al (1993), Foucher et al (2003), and van Rijssen & Werker (2006) present good results on the use of fasciotomy, and its popularity further increased over time[11][12][13]. Recent literature also reported good results of the technique compared with the alternative[14,15].…”