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Symposium 2

Symposium 2. Needle Aponeurotomy for the Treatment of Dupuytren’s Contracture A Prospective Study Gary M. Pess, MD Central Jersey Hand Surgery Eatontown, NJ Nothing of financial value to disclose. Needle Aponeurotomy for the Treatment of Dupuytren’s Contracture A Prospective Study.

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Symposium 2

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  1. Symposium 2 Needle Aponeurotomy for the Treatment ofDupuytren’s ContractureA Prospective Study Gary M. Pess, MD Central Jersey Hand Surgery Eatontown, NJ Nothing of financial value to disclose

  2. Needle Aponeurotomy for the Treatment ofDupuytren’s ContractureA Prospective Study Gary M. Pess, MD Central Jersey Hand Surgery Eatontown, NJ

  3. Why Reconsider Fasciotomy?Gary M. Pess M.D. • High recurrence rate with open surgery • Recovery can be prolonged • Some patients never regain full flexion • Significant surgical complication rate

  4. Hand SurgeonsArePerfectionists!Gary M. Pess M.D. But can we really cure Dupuytren’s Contracture?

  5. Needle AponeurotomyTechnique Gary M. Pess M.D. • Outpatient procedure – office or surgery center • Local anesthesia (rarely MAC) • No tourniquet necessary • Five cc syringe • 1 cc DepoMedrol + 3 cc Xylocaine 1% plain • Short 25 gauge 5/8” needles

  6. Needle AponeurotomyPost Procedure Gary M. Pess M.D. • Exercise fingers immediately • Can wash hand • No heavy grasping for 2 weeks • Night splint for 3 months • Therapy for stiff fingers and residual contracture

  7. Needle AponeurotomyMaterials and Methods Gary M. Pess M.D. • 128 Patients • 260 Fingers • Male : Female - 4 : 1 • Average age: 61

  8. Needle AponeurotomyMaterials and Methods Gary M. Pess M.D.

  9. Needle AponeurotomyMaterials and Methods Gary M. Pess M.D. • Only one procedure per finger • Two patients deceased • Twelve patients lostto follow-up • Minimum follow-up 2.5 years (Range 2.5 - 3.5 years)

  10. ResultsMP Joint Gary M. Pess M.D.

  11. ResultsPIP Joint Gary M. Pess M.D.

  12. ResultsPercent Correction Gary M. Pess M.D. P<.001

  13. Results by DigitMP Joint Final Correction Gary M. Pess M.D.

  14. Results by DigitPIP Joint Final Correction Gary M. Pess M.D.

  15. Results by AgeFinal Correction Gary M. Pess M.D. P<.001 P<.001

  16. Results by GenderFinal Correction Gary M. Pess M.D.

  17. ResultsSuccess in Correcting <= 5º Gary M. Pess M.D. • MP Joint: 97% fingers • PIP Joint: 70% fingers

  18. ResultsJoint Recurrence > 20º Gary M. Pess M.D. • MP Joint: 14% fingers • PIP Joint: 54% fingers

  19. ResultsFinal Improvement >=50% Gary M. Pess M.D. • MP Joint: 81% • PIP Joint: 50%

  20. ResultsComplications Gary M. Pess M.D. • Skin tear: 1.9% (5) – All healed • Temporary Neurapraxia: 1.2% (3) • Tendon or Pulley Rupture: 0% • Nerve Laceration: 0% • Arterial Laceration: 0% • Hematoma: 0% • Infection: 0% • RSD: 0% • Hospitalization: 0%

  21. ConclusionsNeedle Aponeurotomy Gary M. Pess M.D. • Statistically significance difference: MP v. PIP (p<.001) • Statistically significance difference: <= 50 v. > 50 (p<.001) • No difference based on gender or digit affected • Correction of contracture <=5º • MP Joint: 97% • PIP Joint: 70%

  22. ConclusionsNeedle Aponeurotomy Gary M. Pess M.D.

  23. ConclusionsNeedle Aponeurotomy Gary M. Pess M.D. • Needle Aponeurotomy is a safe procedure • Complication rate lower than fasciectomy • Can be performed in an office setting • High patient satisfaction • Excellent procedure for Dupuytren’s Contracture

  24. Surgical Goal Gary M. Pess M.D.

  25. Thank You! Gary M. Pess M.D.

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