What is the difference between needle aponeurotomy and palmar fasciectomy and what are the risks?

Needle aponeurotomy and palmar fasciectomy greatly different

Needle aponeurotomy and palmar fasciectomy are two completely different kinds of Dupuytren contracture surgery.  As with any kind of hand surgery done to release the contractures of Dupuytren disease, each has its own value, risks and limitations.  The risk and limitation of Dupuytren surgery should be considered not only because of the potential permanent consequences (numbness, reduced finger movement, reduced hand strength, reduced sensations and pain) that can occur, but also because hand surgery is not your only Dupuytren therapy option.

Alternative Medicine is a conservative and essentially risk free alternative that could make surgery unnecessary.

Dupuytren’s surgery, even when done well, can have bad unintended consequences as well as stimulate the recurrence of additional nodule and cord formation in the palm.  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

What is a needle aponeurotomy?

Needle aponeurotomy, also called palmar fasciotomy, is considered minimally invasive Dupuytren hand surgery since a scalpel is not used to open the skin of the palm.

Needle aponeurotomy is performed by inserting a hypodermic needle into the palm of the hand with the intention to move the needle tip in a variety of directions to cut, tear and weaken the offending cords and contractures in the palm.  Without being able to see the collagen structures he is slashing with the needle tip, the surgeon blindly attempts to destabilize and release those same cords and fascial contractures that prevent full straightening of the involved fingers.

Because these structures cannot be seen as the needle moves, the risk is that nearby nerves, blood vessels and tendons might be accidentally injured or destroyed

What is a palmar fasciectomy?

There are several types or palmar fasciectomy, depending on how much tissue is removed during this type of hand surgery.  Let us begin with the words, palmar fasciectomy.

Palmar refers to the palm of the hand. Fasciectomy refers to a kind of surgery performed on fascia.  Fascia is the thin, white, tough layer of soft tissue that covers, surrounds and lines all organs, structures, tissues and cavities of the body. You can think of fascia like the clear plastic Saran wrap used to cover and protect food.  When you look in the meat case at the butcher shop you can see all kinds of fascia in the cheaper grades of roasts and steaks.   Because hands need extra support and protection from the heavy work they do, there is normally much fascia in the palm.

The ending “-ectomy” means that the surgery is done through an opening in the skin and something is removed – in this case fascia.   So, a palmar fasciectomy is a surgery on the palm during which fascia is removed.

As an interesting aside the reader will note, above, that needle aponeurotomy was noted to also be called a palmar fasciotomy.  The ending, “-otomy” means that the surgery is done to cut into the body but nothing is removed, not even the fascia. A common “-otomy” surgery is a tracheotomy in which a hole is placed in the trachea, so that breathing can take place through the opening, and noting is removed.  So, a palmar fasciotomy is a surgery on the palm during which no fascia is removed.

Not all palmar fasciectomy is performed the same. The type and extent of a palmar fasciectomy is determined by the patient’s history of previous hand injury and surgical treatment, occupation, age, family genetics and family history of the Dupuytren’s contracture, severity and location of contracture, degree of disability, and general health status.

Different types of this Dupuytren surgery include a complete palmar fasciectomy (rarely done because of typically bad results after such large tissue removal), partial or selective palmar fasciectomy, fasciectomy with skin grafting, and amputation.

 

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