Remember Dupuytrens Disease will always come back. Our interventions are simply a “haircut” to try and normalise things as much as possible.
Here is a link for the most recent National Institute for Health and Care Excellence (NICE) Guidance on this topic.
This is a procedure, performed under local anaesthetic, using a needle to divide the aponeurosis/palmar fascia. -otomy means to cut. Some people call it a fasciotomy. They are the same thing.
On average a needle aponeurotomy lasts 3-4 years. However, the minimally invasive nature of the procedure, the quick recovery, the small, if any, wounds, the fact it’s just a local anaesthetic (rather than general or regional anaesthesia) make it a very popular procedure.
Not everyone with dupuytrens will be suitable for a needle aponeurotomy. Needle aponeurotomy is best for when there are cords (like strings) which are well defined and that stand proud. When the disease is more diffuse (spread everywhere) with no defined cords, then needle aponeurotomy is not appropriate. Lots of people will be somewhere in the middle which would often result in an incomplete straightening of the finger.
A disadvantage of needle aponeurotomy compared to open fasciectomy is that if all the palpable dupuytrens is divided and there is stil a bend in the finger due to the joint being contracted, the joint itself can’t be addressed with a needle aponeurotomy. It is likely that the surgeon would have suspected a joint contracture with you prior to the procedure and as such warned you of the likelihood of an incomplete correction.
Needle aponeurotomy is not an appropriate procedure for straight fingers with Dupuytrens Disease.
Following your needle aponeurotomy, I request my patients wear a night splint for 3 months. There is no good evidence that this makes a difference and practice varies between surgeons significantly. My logic is that you have invested time and discomfort in having the procedure to produce a gap in the cord of Dupuytrens tissue. When we all sleep out fingers flex down and it’s more likely that those two raw ends are in contact with each other. Most people tolerate the night splint well and several of my patients have reported wearing it longer than three months as an extra security blanket.
Collagenase / Xiapex / Xiaflex / Collagenase Clostridium Histolyticum (CCH)
Here is a patient information link for Xiapex (the name in the UK for Collagenase).
Please remember this is from a company that is selling the Collagenase!!