Comparison of NA and limited fasciectomy, surgical indications:

AL Van Rijssen and collcompared in a randomized controlled trial needle aponeurotomy and limited fasciectomy (LF) for Dupuytren’s contracture as first line treatment26. 125 hands (121 patients) were randomized for LF or NA as described by JL Lermusiaux. Outcome was evaluated 1 and 6 weeks after. After six weeks the improvement of global contracture was higher after LF then NA (79% vs. 63 %) but with no statistical difference between the two treatment strategies for Tubiana stage 1 and 2. For higher stages, results were higher after LF then NA, respectively 75% vs. 46% improvement in passive extension deficit for stage 3 and 79 % vs. 47 % for stage 4. This could be explained by the fact that in this study, only one session of NA was performed for all Tubiana of Dupuytren’s contracture.

The rate of complications was clearly in favour of NA with 5 % major complications (hematoma, nerve injury and infection) after LF, vs. 0 % after NA. At six weeks there were no patients in the NA group with flexion deficit compared to 19 patients out of 56 in LF group.

Patient treated with NA were more satisfied with the function of their hand at 6 weeks than those treated by LF (p=0.002), with lower degree of discomfort.

Today, one can admit the superiority of surgery only in case of frequent reoccurrence by use of skin graft, failure of needle aponeurotomy, buttonhole deformity and irreducible stiffness of the PIP joint by arthrolysis or arthrodesis.