Percutaneous needle aponeurotomy and fat injection for the treatment of dupuytren's contracture

Abstract

Background: Among the various procedures that have been used to treat Dupuytren's contracture, percutaneous needle aponeurotomy (PNA) is a popular technique with the disadvantage of a high recurrence rate. The purpose of this study is to combine PNA with autologous fat grafting to correct the contracture, return the palmar surface to its normal appearance and feel, and reduce recurrence. Patients and Methods: Thirty-three patients were operated of whom thirty were successfully followed up for 1 year. Forty-two rays were operated on all patients undergoing magnetic resonance (MR) imaging before and after the surgery. All patients had the contracture released by the way of PNA followed by fat grafting. Results: Hand examination revealed a smooth, painless, and soft skin, with an overall improvement rate of 90.1% 1 year postsurgery, presenting a recurrence rate of 18.6% that is significantly lower when compared to other studies performing PNA alone. MR evaluation showed regression in the pathologic cords and stability in the volume of the fat grafts. A minor complication rate of 23.9% and a major complication rate of 6.5% specific for PNA were observed. Conclusion: PNA is a minimally invasive technique that can be used for the treatment of contractures in almost all stages of Dupuytren's disease. Autologous fat grafting can be useful in offering the subcutaneous tissue a soft appearance and feel and preventing recurrence by filling in the potential space by fat instead of fibrosis, preventing expansion of the local mesenchymal progenitor cells responsible for the disease.

Keywords

• dupuytren's contracture
• fasciotomy
• fat graft
• lipofilling
• percutaneous needle aponeurotomy