PERCUTANEOUS NEEDLE APONEUROTOMY AND LIPOGRAFT FOR DUPUYTREN’S DISEASE- OUR EXPERIENCE IN FOUR WEEKS FOLLOW UP

Abstract

Background: Dupuytren‘s disease is progressive disorder, which affects the palmar fascia and results in irreversible flexion posture of the fingers. Etiology is unknown and significant risk factors include old age, male sex, white northern European extraction, presence of positive family history of Dupuytren’s disease, and diabetes mellitus.[1] Treatment is mainly surgical resection but it carries a long recovery period and significant rate of complications. Objective: To present our experience with a minimally invasive technique of percutaneous needle aponeurotomy (PNA) and lipografting Methods: The procedure of PNA and lipografting consists of percutaneus needle aponeurotomy, which is Lermisiaux modified technique and subdermal lipofilling. After the contracture release using a small hypodermic needle we inject the space between subcutaneous tissue and fascial cord with autologous lipoaspirate. We treated 15 patients with 22 rays. Primary outcome measures were total passive extension deficit improvement at one week and 4th weeks. Results: The average total passive extension deficit (TPED) before treatment measured 86,33° at ray and postoperative mean TPED measured 22,13°.Immediately after release the mean flexion contracture correction of metacarpophalangeal (MCP) joint was from 44,33° to 1,38° degrees with 100% improvement rate. For proximal interphalangeal (PIP) joint the mean flexion contracture correction was from 51,25° to 23,75°. Patients were able to return to their normal activities after one week. We met only minor complications. Conclusion: The procedure is minimally invasive and has short recovery time. It provides the possibility of treating multiple rays ‘s and the hand as a whole with no major complications.

Keywords

• Dupuytren’s disease
• contracture
• percutaneous needle aponeurotomy
• lipograft