A Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren’s Disease: A 6-Week Follow-Up Study

Rijssen, Annet L. van; Gerbrandy, F.; Linden, Hein ter; Klip, Helen; Werker, Paul M. N.

doi:10.1016/j.jhsa.2006.02.021

Cited by 247 publications

(214 citation statements)

References 14 publications

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“…The benefits of PNA include the ability to perform the procedure under local anesthesia in an outpatient setting, which minimizes risk to the patient, as well as a quicker recovery rate compared with open surgery. 29,31 However, the procedure suffers from a high recurrence rate and is less effective than fasciectomy at treating severe contracture. 29,31 In addition, despite the lesser risk, complications including damage to nerves and tendons and formation of pseudoaneurysms have still been reported.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014

Lipman

Carstensen

Deal

2016

Hand (New York, N,Y.)

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Background: Dupuytren disease is a common fibroproliferative disorder. Multiple procedural treatment options are available, with Collagenase Clostridium Histolyticum (CCH) injection being introduced in 2010. The purpose of this study was to investigate trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Methods: The PearlDiver Humana database was queried using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes for patients with Dupuytren disease that received percutaneous needle aponeurotomy (PNA), fasciotomy, fasciectomy, and CCH injection. Patients were filtered by age, number of comorbidities, and gender. Change in composition of treatments over time was analyzed for each demographic group between 2007 and 2014. Results: Patients presenting to clinic for Dupuytren disease increased from 1118 to 3280, with unchanging treatment percentage of 41. Percent fasciotomies and fasciectomies decreased from 5% to 3% and 33% to 21%, while CCH injection increased to 11% by 2012 to 2014. Percent fasciotomies decreased (P < .05) in younger healthier (age <65, 0-1 comorbidities) and older less healthy (age 65-74, 4+ comorbidities) populations. Percent fasciectomies decreased significantly in nearly all age and comorbidity groups, but by greater amounts in patients with 2+ comorbidities with increasing age. Percent CCH injections increased in all groups, at rates similar to the losses seen in open procedures. Conclusions: CCH injections have risen to substantial levels, with corresponding decreases in the percentage of patients receiving fasciotomies and fasciectomies. Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity.

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Section: Discussionmentioning

confidence: 99%

Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014

Lipman

Carstensen

Deal

2016

Hand (New York, N,Y.)

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“…Four studies utilized Z-plasty for skin management whereas two performed dermatofasciectomy with local wound care. Three studies describing needle aponeurotomy met the inclusion criteria [4,10,17]. One study was a comparative study with a needle aponeurotomy arm (level III), and two studies were retrospective cohort studies (level IV).…”

Section: Study Characteristicsmentioning

confidence: 99%

A Systematic Review of Outcomes of Fasciotomy, Aponeurotomy, and Collagenase Treatments for Dupuytren's Contracture

Chen

Srinivasan

Shauver

et al. 2011

Hand (New York, N,Y.)

114

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Background Needle aponeurotomy and collagenase injection are alternative treatments of Dupuytren's contracture to open partial fasciectomy; however, reported data are difficult to interpret without a formal systematic review. Methods A Medline, EMBASE, and Cochrane database search was performed, and 277 articles were identified. Articles were stratified by level of evidence, and those of the highest level for each technique were included. Evidence available for needle aponeurotomy was of low quality so only cohorts larger than 100 patients were included. Results The sample size of patients for open partial fasciectomy ranged from 37-261. The recurrence rate ranged from 12-39%, with mean follow-up time of 1.5-7.3 years. The complication rate ranged from 14-67%. Complications included nerve division (2-5%), infection (4-12%), neurapraxia (0.4-52%), and regional pain syndrome (2-13%). For needle aponeurotomy the sample size ranged from 117-211. The recurrence rate ranged from 50-58%, with mean follow-up time of 3-5 years. With regard to collagenase injection, the sample size ranged from 13-204. The recurrence rate ranged from 10-31%, with mean follow-up time of 120 days to 4 years. For the two latter procedures, adverse effects consisted primarily of skin tears (9-25%). Kruskal-Wallis testing demonstrated that the recurrence rate was significantly higher for needle aponeurotomy than for open partial fasciectomy (p=0.001), and the recurrence rate was significantly higher for open partial fasciectomy than for collagenase injection (p=0.001). Conclusions The recurrence rates and types of complications differ between open partial fasciectomy and needle aponeurotomy or collagenase injection. Long-term outcomes have not been well reported.

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“…Un estudio reciente comparando esta técnica con fasciectomía abierta a las 6 semanas de evolución demostró una mejoría del déficit de extensión pasivo de 63%, comparado con una mejoría de 79% del grupo de fasciectomía abierta. Respecto a las complicaciones hubo un mayor número de complicaciones menores (lesiones de piel y parestesias) en el grupo percutáneo versus fasciectomía, sin embargo el grupo percutáneo no tuvo complicaciones mayores, las que si se presentaron en el grupo quirúrgico (lesión de nervio digital, infección y hematoma) 34,35 . La fasciectomía parcial es el método quirúrgi-co más utilizado y aceptado en todo el mundo, y consiste en la escisión quirúrgica sólo del tejido macroscópicamente comprometido, lográndose una baja tasa de complicaciones y morbilidad post-operatoria.…”

Section: Tratamiento Quirúrgicounclassified

Enfermedad de Dupuytren: revisión

2012

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Dupuytren disease (DD) is a connective tissue disorder that consists in fibromatosis of the palmar and digital fascia (in form of nodules or flanges) that leads to theL a enfermedad de Dupuytren (ED) es una condición benigna del tejido conectivo, caracterizado por un desorden fibroproliferativo (fibromatosis benigna) que afecta fundamentalmente a la aponeurosis palmar y digital, provocando contracturas y deformidad progresiva en flexión en la región palmar de mano y dedos, cuya causa y mecanismo fisiopatológico aún permanecen parcialmente comprendidos.El primer caso de esta condición fue descrito por el médico suizo Félix Plater en 1614 (quien le atribuyó una causa traumática), siendo luego descrito por otros autores como H Cline, en 1777 y por Ashley Cooper, en 1822; sin embargo, el nombre del médico francés Guillaume Dupuytren predominó para esta condición, quien en 1831 describe en detalle la fibromatosis localizada en la aponeurosis palmar, realizando la primera cirugía de fasciotomía abierta.Esta enfermedad se caracteriza por el desarrollo de contracturas en flexión, de la palma y de las articulaciones digitales, secundaria a la formación de nódulos y bandas fibrosas o bridas [1][2][3][4][5] . Afecta principalmente la región palmar distal en relación a los dedos anular y meñique, produciendo la flexión progresiva e irreversible de las articulaciones metacarpo-falángicas (MTCF) e interfalángicas proximales (IFP). EpidemiologíaEn relación a la prevalencia de esta enfermedad, destaca que es un cuadro que sucede en toda la población, pero en diferente proporción y frecuencia dependiendo de la carga genética y de las comorbilidades del paciente. La incidencia de esta patología aparece mayor en los países del norte de Europa y emigrantes provenientes de esas zonas; mientras que es rara en países africanos y Asia oriental. La prevalencia reportada en otros países es de 1,7 a 2% en varones adultos mayores de 50 años en la población general, siendo de 3-6% en adultos caucásicos. En Escocia, Noruega e Islandia se ha reportado una incidencia de hasta 40% en ciertas comunidades, mientras que su presencia en poblaciones de raza negra y de Asia oriental es de escasa ocurrencia. Es siete a diez veces más frecuente en hombres que en mujeres. Para esto aún no hay explicación, sin embargo los miofibroblastos en la ED tienen una mayor expresión de

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A Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren’s Disease: A 6-Week Follow-Up Study

Cited by 247 publications

References 14 publications

Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014

Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014

A Systematic Review of Outcomes of Fasciotomy, Aponeurotomy, and Collagenase Treatments for Dupuytren's Contracture

Enfermedad de Dupuytren: revisión

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