What is needle aponeurotomy or palmar fasciotomy and what are the risks?

Alternative Medicine: Safer alternative than needle aponeurotomy  

Before discussing the Dupuytren contracture surgery known as needle aponeurotomy (NA) and its inherent risks, it is important for the reader to know there is a conservative alternative therapy that avoids the possible side effects and adverse reactions of needle aponeurotomy, also called palmar fasciotomy.  Any Dupuytren’s surgery, even when done well, can have bad unintended consequences as well as stimulate the recurrence of additional nodule and cord formation within a year or two.

Needle aponeurotomy, and other kinds of Dupuytren surgery, is not the only treatment option available.   Alternative Medicine is a conservative and essentially risk free alternative that could make surgery unnecessary.   Most people agree that it makes more sense to use conservative options first, followed by more aggressive and risky options if they are still needed.  However, in the case of Dupuytren contracture most patients are unaware they have other options outside of surgery.

Since 2002 this website has suggested that anyone with Dupuytren contracture should first consider the conservative non-surgical and non-drug treatment options before attempting irreversible surgery.  To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

While all medical websites approach the subject of Dupuytren treatment as though hand surgery and Xiaflex injections are the only options to consider, they intentionally avoid the many diverse Alternative Medicine options that are easy to incorporate and can be used with practically no risk at all. Please read Conservative Philosophy for Dupuytren Therapy

Medical doctors discuss Dupuytren surgery risks

For verification of the risks associated with Dupuytren surgery simply read what hand surgeons have to say.  If the reader goes to the website of a surgeon who specializes in needle aponeurotomy you can read about the dangers of open hand surgery like fasciectomy or even Xiaflex injections.   And, if the reader goes to the website of a surgeon who specializes in open hand surgery you can read about the dangers of needle aponeurotomy.

Each surgical procedure obviously has pros and cons about it, and it us up to the informed patient to know the best option to use.  The intention of this article to simply say that all surgery has a certain level of built-in risk that is best avoided if at all possible.

Risks of needle aponeurotomy

The surgeon cannot see the tip of the needle or the actual tissue being sliced and torn during a needle aponeurotomy, since there is no surgical incision made when performing a needle aponeurotomy.  The surgeon inserts the needle that is used to do the cutting and slicing, and must rely on a high level of skill to only contact and destroy the Dupuytren cord – and nothing else.

There are two risks involved. The first risk is that normal and healthy tendon, ligament, blood vessel and nerve tissue can be accidentally cut instead of the intended targets of palmar fascia contracture and Dupuytren cords.

However, the second risk is greatest.  After a palmar fasciotomy or needle aponeurotomy is done, the cutting and tearing of the Dupuytren contracture tissue accelerates the time for recurrence of another episode of Dupuytren’s contracture when compared to conventional open hand surgery.   The reality of this hand problem is that the contracture will come back at some point after any Dupuytren intervention, and recurrence is statistically faster after needle aponeurotomy than after other types of hand surgery.

Difference between needle aponevrotomy and needle aponeurotomy

There is a simple reason for the difference in terminology encountered while learning about Dupuytren treatment.  Many people find it confusing to occasionally see aponeurotomy spelled a little differently, as in the phrase “needle aponevrotomy.”

Needle aponevrotomy is not an accidental misspelling of needle aponeurotomy. It is simply a matter of a French word being used because the earliest and most innovative development of needle aponeurotomy was done in France, hence the occasional use of the French terminology needle aponevrotomy; both words refer to the same procedure.

Needle aponeurotomy is Dupuytren surgery  

In medical terminology an “-otomy” is a surgical procedure in which the body is cut into, but nothing is removed.  Familiar examples are: tracheotomy, laparotomy, phlebotomy.

The reader will occasionally come upon another –otomy, the term palmar fasciotomy to describe needle aponeurotomy.  In a fasciotomy a type of tissue called fascia is cut but not removed.   Fascia is a kind of thin but tough layer of connective tissue that surrounds, covers and lines all major organs, tissues and cavities of the body.  There is fascia – a lot of it – under the skin on the palm of hand.  During a needle aponeurotomy fascia is cut but not removed, qualifying for this surgery to be called a palmar fasciotomy.

Further, in medical terminology an “-ectomy” is a surgical procedure in which the body is cut into, and something is removed.  Familiar examples are:  Tonsillectomy, appendectomy, and vasectomy.

The reader will also occasionally come upon another –ectomy, as in palmar fasciectomy which is an open hand surgery during which an incision is made to allow for removal of part or all contracted fascia of Dupuytren contracture.   During a palmar fasciectomy sometimes so much fascia and skin is removed that sometimes a skin and fascia graft must be done.

Therefore, a needle aponeurotomy is a surgical procedure that is performed by inserting a needle into a site of deep palmar fascia contracture and nothing is removed.  Instead, once under the skin of the palm, the needle tip is moved blindly around in a variety of directions to intentionally slash, weaken and otherwise disrupt the contracted palmar tissue that causes the reduced finger movement and flexion contracture of Dupuytren’s disease.

Comments

2 Responses to “What is needle aponeurotomy or palmar fasciotomy and what are the risks?”
  1. Ted Price says:

    I’m a World War II veteran, on warfarin, with CHF, and pacemaker and defibrillator. I’m 88 yrs old, almost 89. I’ve just learned I have early Dupuytren’s contracture. I dread any surgery and realize the dangers of needle aponeurotomy to surgically correct the Dupuytren’s contracture.
    01.How can I learn of alternative conservative methods with a doctor in Northwest Georgia usa.
    02.WILL MEDICARE PRIMARY AND BLUE CROSS SECONDARY COVER TREATMENT.
    03.Would appreciate an email with these answers an any further help.

  2. Dr.Herazy says:

    Greetings Ted,

    You are correct to avoid any hand surgery for your Dupuytren’s contracture until you have given a good effort to see if Alt Med might not help your hand. All these different Dupuytren’s contracture surgeries do not cure the problem, they just give a few years delay because the Dupuytren’s contracture tissue always recurs or comes back. A needle aponeurotomy even when done well will tear and disrupt a lot of tissue, sometimes causing new nerve and blood vessel damage in addition to the DC lump and cord development that will recur. It is inevitable because that is the nature of more fibrous material to develop when you cut into Dupuytren’s contracture.

    I know of no one who practices alternative conservative medicine in NW Georgia, sorry. And Medicare and BC/BS will not cover much or any of Alt Med treatment, sorry again. You can use the information how to Alt Med to work with your Dupuytren’s contracture on your own. That is why we have DCI available for you. Good luck with your Dupuytren’s contracture treatment. TRH

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