Dupuytren's contracture: an analysis of outcomes of percutaneous needle fasciotomy versus open fasciectomy.
BACKGROUND
Percutaneous needle fasciotomy (PNF) is a minimally invasive technique used to manage Dupuytren's contracture. We compared outcomes of PNF versus open fasciectomy (OF) to examine the suitability of PNF in Australia.


METHODS
A retrospective cohort study using two questionnaires regarding Dupuytren's treatment was used to assess patients with uncomplicated primary disease. The primary outcomes were immediate and medium-term correction of contracture (2-year mean follow-up to time of survey). Secondary outcomes were patient satisfaction and complications including tendon/nerve injury, infection, skin necrosis and vascular damage.


RESULTS
One hundred fifty-five out of 191 surveys were returned (81%). The final analysis included 125 cases (65%), 73 PNF and 52 OF. No significant differences were observed between both groups with regards to follow-up time, gender, smoking status, co-morbidities or preoperative deformity grade. No significant differences were observed in terms of immediate or medium-term deformity correction, tendon/nerve injury or circulatory complications. The postoperative infection rate was higher with OF, with these patients 7.57 (95% confidence interval 1.56, 36.77; P = 0.01) times as likely to have a postoperative infection as patients undergoing PNF. A higher number of patients who underwent PNF were told that they would require another operation (30% versus 12%; P = 0.02). Satisfaction scores were similar (OF 33.2 versus PNF 32.6; P = 0.82).


CONCLUSIONS
The OF and PNF procedures provide comparable deformity correction for uncomplicated primary Dupuytren's disease in the immediate perioperative period. The reduced side effect profile of PNF should prompt surgeons to consider incorporating it in their practice for the first-line management of uncomplicated primary Dupuytren's disease.
Peninsula Clinical School, Monash University, Frankston, Victoria, Australia.
Jason T
JT
Toppi
Peninsula Clinical School, Monash University, Frankston, Victoria, Australia.
Leisel
L
Trompf
Peninsula Clinical School, Monash University, Frankston, Victoria, Australia.
Nicolas R
NR
Smoll
Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia.
Vivian
V
Lim
Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia.
Katrina
K
Smith
Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia.
Michael W
MW
Findlay
Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia.
David J
DJ
Hunter-Smith
D000368:Aged; D004387:Dupuytren Contracture / Q000503:physiopathology / Q000601:surgery*; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D019637:Orthopedic Procedures / Q000295:instrumentation*; D017060:Patient Satisfaction; D020127:Recovery of Function; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
Dupuytren contracture; fascia/surgery; hand surgery; minimally invasive/method; needle; surgical procedure