1. Dupuytren’s Disease: Percutaneous Release
Charles Eaton MD
2007

2. Why? Why? …WHY? Conventional Wisdom: Fasciotomy:
Is Dangerous
Is Ineffective
Is Always Followed by Rapid Recurrence
Reality: In 2007, Compared to Surgery, Percutaneous Needle Fasciotomy:
Is Far Safer in Terms of Flare Reaction, RSD, Stiffness, Nerve Injury
Nearly as Effective
Does have earlier recurrences 50% recurrence: Fasciectomy:5 yr; NA:3 yr
Has Far Less Morbidity
Has Far Better Overall Patient Satisfaction

3. Needle Aponeurotomy (NA) Percutaneous Needle Fasciotomy (PNF)
Principles: Needle used as scalpel Multiple levels of release Passive extension separates cords Cords slide relative to skin Minimal skin trauma Minimal deep dissection Surface anesthesia safety net Fascia=sheet; Cord=string

5. BD PrecisionGlide™ Needle
Cutting portion of bevel =0.87mm
≈0.5mm diameter
Modified Trochar Design
25 Gauge Needle
Needle Geometry
25 Gauge Needle
BD PrecisionGlide™ Needle

6. Cutting edge of 25 Gauge Needle
Stab 0.5mm wide { {
Maximum Slice depth < 1mm

7. Wound Geometry and Collateral Damage Zones
25 Gauge Blade Blade

8. Fasciotomy Geometry Transverse releases
Lenticular expansion similar to expanded sheet metal

9. Needle Technique
Initial entry:
Define cord
Clear septae

10. Needle Technique: Stab
Radial Stab
Useful for large cords, fixed skin
Linear Stab
Useful for small incremental progress

11. Needle Technique: Slice
Tip Slice
For thick cords
Bevel slice
For wide cords

12. 1. Start with Skin Crease Landmarks
Portal Diagrams
1. Start with Skin Crease Landmarks

13. 2. Add Common Dupuytren Zones
Portal Diagrams
2. Add Common Dupuytren Zones

14. 3. Subdivisions based on Zones and Creases
Portal Diagrams
3. Subdivisions based on Zones and Creases

15. Portal Diagrams
Eaton Zones

16. Office Needle Technique Preop
Palpate cords
Doppler spiral suspects
Diagram cords, nodules, scars, ROM
Review
Expectations for ROM and recurrence
Technique
Paresthesias
Active finger flexion
Postop program
Consent

17. Office Needle Technique
Tiny intradermal skin wheal anesthesia
25 gauge 5/8” Needle
Bevel perpendicular to cord
Release distal to proximal in fingers
PIP anesthetic if contracture > 60º
Monitor:
Nerve: Tip sensibility
Tendon: Active flexion with needle inserted
Final manipulation +/- block
Local anesthetic / steroid injections
Diagram portals, events, ROM
Bandage

18. Office Needle Technique Postop
Bandages off same day if no skin tears
36 hr Ice / Elevation
1 week no soiling / no strenuous activities
Postop pain is uncommon
Postop paresthesias are common – few days
Expect nodules to soften for 3 weeks
Local Histamine type flare common at 6-8 wks Rx Topical Benadryl, Hydrocortisone
3 month static night splint if PROM>>AROM
PIP: finger splint
MCP: hand based pan splint
Combined: intrinsic(+) position

19. Demonstration

21. ?? Technique Comparison Fasciectomy NA
Long Recovery Complications Common Chance for Cure NA
Short Recovery Complications Rare Recurrence Common