For disabling hand contractures caused by Dupuytren's disease, patients prefer a percutaneous needle fasciotomy procedure despite the higher contracture recurrence rate when compared to conventional surgery. These findings are the results of a clinical trial report in the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Many patients still prefer needle fasciotomy because it is a less-invasive procedure with a shorter recovery time. The new study was led by Dr. Annet L. van Rijssen of Isala Clinics, Zwolle, the Netherlands.
Study Directly Compares Two Approaches for Dupuytren's Contractures
Patients with Dupuytren's disease develop hand deformities caused by abnormal deposits of connective tissue. In advanced cases, some type of surgery is needed to release connective tissue "cords" causing deformity and restricted motion (contractures) of the hands.
In recent years, percutaneous needle fasciotomy has been introduced as an alternative to more extensive surgery (called limited fasciectomy) for treatment of Dupuytren's disease. In needle fasciotomy, the surgeon places a needle through the skin to break up the connective tissue cords restricting hand function. Requiring no incision and only a local anesthetic, the needle procedure has a much shorter recovery time. In contrast, limited fasciectomy requires incisions of the hand and fingers and general or regional anesthesia, with a longer recovery time.
The new study—the first to directly compare the long-term outcomes of the two procedures—included 111 patients with advanced Dupuytren's disease and severely limited hand motion. (Four patients had both hands operated on, for a total of 115 hands.) Patients were randomly assigned to undergo needle fasciotomy or limited fasciectomy; the results were assessed through five years after treatment.
During follow-up, patients who underwent needle fasciotomy had a higher rate of recurrent contractures: 85 percent over five years, compared to 21 percent with limited fasciectomy. Contractures also occurred earlier in hands treated by the needle procedure—most often within one or two years.
Not surprisingly, patients who underwent limited fasciectomy had higher satisfaction scores. However, despite the high recurrence rate, most patients undergoing needle fasciotomy were also satisfied with their results.
Even after they developed recurrent contractures, many patients opted to undergo another needle procedure, rather than the more extensive fasciectomy procedure. "This indicates that many patients are likely to prefer a minor procedure with fast recovery at the expense of a higher chance of an early recurrence," Dr. van Rijssen and coauthors write.
The risk of recurrence was lower for older patients. Aside from the type of treatment, no other patient characteristics affected the risk of recurrence.
The study provides important new data on the expected outcomes of the two treatment options for advanced Dupuytren's disease. The 85 percent recurrence rate is higher than in previous studies of needle fasciotomy, probably because of the longer follow-up time.
However, the needle procedure still has a role to play in the treatment of Dupuytren's contracture, depending on patient characteristics and preferences. Dr. van Rijssen and colleagues conclude, "We believe that needle fasciotomy is best suitable for well-informed elderly patients with relatively mild contractures…and for those who are willing to accept a higher recurrence risk in the context of a lower complication rate, fast recovery, and minimal invasiveness."
Plastic and Reconstructive Surgery