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Winter 2009

Minimally Invasive Procedure Can Free Frozen Fingers

01/01/2009

 

Needle aponeurotomy offers quicker procedure with fewer complications, less pain and faster recovery.

A minimally invasive alternative to conventional open surgery can help people who suffer from Dupuytren’s contracture, a debilitating condition that results in one or more fingers becoming permanently bent.

Dupuytren’s contracture is an often-inherited progressive condition in which cords of tissue in the palm thicken and shorten, pulling fingers into a bent position that cannot be straightened. The bending usually occurs in the knuckle or middle joints of the ring finger and pinkie, but other fingers and joints may also be involved.

“While the condition is rarely painful, bent fingers complicate a patient’s life,” says Prosper Benhaim, M.D., UCLA hand and reconstructive surgeon. “Everyday activities such as shaking hands, putting on gloves and using a computer keyboard are very difficult. It is easy to poke yourself in the eye while just combing your hair.”

Conventional open surgery to correct the condition involves a sometimes large incision in the palm and fingers to remove diseased tissue. Recovery can take several months, and some patients experience complications such as nerve damage, infection, stiffness or a chronic-pain syndrome called reflex sympathetic dystrophy.

The alternative procedure is called needle aponeurotomy; it is has been performed in Europe since the 1970s, but only recently has been introduced to the United States. Dr. Benhaim is one of the few surgeons in the United States to do the procedure. Rather than cutting into the hand, the surgeon inserts a needle, under local anesthesia, into the palm to divide, loosen and then break the contracted tissue, allowing the fingers to again lie flat.

Compared to conventional surgery for Dupuytren’s contracture, needle aponeurotomy is fast (as little as 10 minutes to complete), has a shorter recovery period (seven to 10 days, with no rehabilitation necessary and little or no need for pain medication) and has fewer complications, and it is much less expensive.

However, not all patients with Dupuytren’s contracture are good candidates for needle aponeurotomy. The best candidates are those in which the contracture is isolated to the knuckle joint, close to the palm, Dr. Benhaim says. Patients with contracture in the middle joint of the finger are sometimes poor candidates due to proximity of a nerve.

And needle aponeurotomy is not without risk, Dr. Benhaim cautions. It is a “blind” procedure, meaning that the surgeon works under closed skin and is not able to visualize the tissue; he must rely on his experience, knowledge of anatomy and expertise to ensure that he does not damage tendons or nerves. Fortunately, the risk of a significant complication is less than one percent overall, Dr. Benhaim says. In addition, as with conventional open surgery, the condition may reappear and the procedure may need to be repeated. Unlike conventional surgery, however, repeat aponeurotomy can be performed much more easily several times over the course of a patient’s lifetime, Dr. Benhaim notes.

Watch Dr. Benhaim perform a needle aponeurotomy http://streaming.uclahealth.org/frozenfingers





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