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.

Dupuytren Release

Dupuytren release is not one type of hand surgery

The term Dupuytren release refers to either of two types of hand surgery: fasciotomy or fasciectomy.  Either of these can be provided to release the thickened and shortened contracture of the hand lump associated with Dupuytren’s disease, resulting in a temporary reduction or release of the tightening and flexion of one or more fingers.

When considering undergoing a Dupuytren release, remember that no release procedure offers a permanent correction; all are a temporary solution because recurrence of Dupuytren contracture will happen sooner or later, usually within three to five years or so.

Dupuytren surgery should be reserved for situations in which the hand contractures keep the involved finger(s) at 30° flexion, or when the individual has a positive tabletop test in which both the palm and fingers  cannot be held flat against a tabletop.

A Dupuytren release involves making one or a series of incisions into the palm to remove the  thick, contracted and inflamed soft tissue (fascia) that surrounds, supports, and separates the tendons and tendon sheaths of the fingers and hand, while preserving the uninvolved skin, arteries, veins and nerves, correcting joint deformities, and maintaining proper flexion and grip strength.

There are five different surgical methods that are termed a Dupuytren release:

  1. Partial or selective fasciectomy – most common Dupuytren release, during which one or more incisions are made across the palm, dependent upon the size, depth and location of the nodules, cords and contractures, as well as history of prior Dupuytren release surgeries and hand trauma, age and occupation. Recurrence  somewhat more frequent than after other types of Dupuytren surgery.
  2. Subcutaneous fasciotomy – Less common Dupuytren surgery.  Single or multiple incisions (usually in a zig-zag pattern) for widespread dissection over the contracted tissue, but diseased tissue is not removed.  Recurrence is slightly more frequent than a regional fasiectomy.
  3. Complete fasciectomy – Rarely indicated because of frequent complications and frequency of recurrence. .
  4. Fasciectomy with skin grafting – Less common Dupuytren surgery.  Surgical removal of diseased skin and fascia overlying Dupuytren cords, in which diseased soft tissue of palm replaced with a skin graft from patient’s forearm.   Recurrence is somewhat less frequent than regional fasciectomy.
  5. Amputation – performed after failed Dupuytren release surgery or after multiple recurrences where no additional surgery is possible.

Dupuytren release not a cure

A Dupuytren release does not cure or eliminate the disease.  When it works out well it will only temporarily modifies the progression of the disease and temporarily improves hand function. When it does not work out well it can result in a worse problem than before the release surgery.  Recurrence is still likely after Dupuytren surgery

Since 2002 the Dupuytren Contracture Institute has maintained that an initially conservative approach to treatment is most prudent and defendable.  If after following a moderate term course of intense non-invasive Alternative Medicine treatment of Dupuytren contracture there is a lack of sufficient response, then more radial invasive measures can always be explored.

The normal and full use of your hands can be taken from you as Dupuytren contracture progresses.  There is an alternate way to do all that you can, as early as you can, to allow your body the best opportunity to naturally reverse this problem.

For ideas and suggestions to organize an effective Alternative Medicine treatment plan, to possibly avoid the need for Dupuytren release surgery, click natural Dupuytren Treatment Plan.

For more information about trying to avoid Dupuytren surgery:

>> Dupuytren Contracture Treatment – FAQs

>> Testimonials from Dupuytren Contracture Institute

>> Dupuytren surgery