Francois J Duminy

PLASTIC & RECONSTRUCTIVE SURGEON

Du Puytren's Needle Fasciotomy

After many years in practice, it became clear that the DuPuytrens contractures often recurred despite excellent initial results.

Bearing this in mind, it seemed sensible to opt for the simplest procedure that would solve the existing problem

Our own practice has always been as follows:

  • The Anaesthetist gives light conscious sedation and a simple direct local anaesthetic blocks are used to numb the affected parts hand. A tourniquet is seldom needed
     
  • We make small needle punctures in the numb hand and use the tip of the needle to cut the fibrous bands which have been placed under some tension by the surgical assistant. The surgeon can feel the bands dividing and the release progressing. Much of the procedure is done by "feel".
     
  • Our knowledge of the local anatomy, gained from many hand operations, is all we have to protect nerves and vessels. We therefore cannot apply this method when the bands are dangerously close to important structures.
     
  • We sometimes inject Hyalase through the needle to soften and further weaken the fibrous tissue masses
     
  • There are only "needle stick" wounds. No sutures are required.
  • Soft dressings with compression bandages are applied to the hand.
     
  • Pre- and post-operative Physiotherapy is recommended.
     
  • Bandages are usually removed by the 2nd day and the patient can then wash and use the hand normally
     
  • The patient is encouraged from the beginning to move the hand through a full range and the Physiotherapists and Occupational Therapists help us to maintain that range through the healing process, sometimes by exercise and sometimes by wearing splints at night.
     
  • We often do both hands at the same time, as the hands recover rapidly enough to carry out essential tasks.
     
  • Many of our patients have been able to play golf within 5 days of the procedure.

 

Benefits experienced by most patients:

1. Improved mobility and function of the hand

2. Fingers don't get stuck in pockets

3. Handshake greetings are less awkward

4. Rapid recovery to improved function, No wounds or scars to heal.

5. Great decrease in "down time", every day is precious when you get a little older!

 

Negative Aspects:

1. Swelling and bruising in the first one or two days requires elevation of the hand

2. Sensory Changes can occur especcially when straightening a finger causes a nerve to be stretched. They usually recover in a few months

4. Lumps of Fibrous tissue are not removed. (Many disappear once the tension stresses have been removed by the division of the bands)

5. The Du Puytren's Contractures may recur after a while, but by then patients have reaped the benefits and have learned that early intervention in a simple way is best. Returning for a repeat procedure only takes a day or three out of a busy schedule.