Dupuytren's Contracture

Dupuytren's Contracture is a common problem that develops most frequently after age 40. It is more common in men than women, though both can be affected. It is usually hereditary occurring in people of European and Western Asian ancestry. It is unusual in Oriental or African-Americans. Dupuytren's usually starts as a painless nodule in the palm. It can progress to fibrous cords extending into the fingers, most commonly ring and little. These bands can cause contracture of the fingers. It can progress slowly or rapidly. The flexor tendons are not affected.

Partial palmar fasciectomy, the traditional treatment for Dupuytren's Contracture, is performed at Central Jersey Hand Surgery by highly skilled board certified Hand Surgeons. The diseased contracted fascia is excised and the fingers carefully straightened.

There are two newer treatments for Dupuytren's Contracture that avoid the long recovery, complications and scarring of open surgery. They are Needle Aponeurotomy (NA) and Xiaflex.

Needle Aponeurotomy (also known as NA), a minimally invasive treatment, has been available at our Northeast Center for Dupuytren's Contracture since 2004. This treatment was developed by Dr. Lermusiaux at the Hôpital Lariboisière in Paris, France and has been performed for over 30 years. Dr. Lermusiaux and his colleagues have published data describing the success and safety of the procedure.

Dr. Pess and Dr. Atik have both visited Dr. Lermusiaux in Paris and were personally instructed in the technique. The treatment can be performed on one hand at a time, takes ~15-20 minutes and can be done with or without light sedation. There is no incision and no sutures are necessary. A light dressing is applied and the fingers can be moved immediately. Over 3,000 fingers have already been straightened safely utilizing NA.

NA was featured in the New York Times. Dr. Pess and Dr. Atik are listed as two of the Certified Hand Surgeons in the USA who perform the procedure.

In May of 2008, Dr. Gary Pess presented his preliminary results of NA at the Nineteenth Annual Richard J Smith, M.D. Resident and Fellows Conference at Massachusetts General Hospital in Boston, MA.

Click here for a Handout of the talk

In September of 2008, at the Sixty-Third Annual Meeting of the American Society for Surgery of the Hand in Chicago, IL, Dr. Gary Pess presented his prospective study: Needle Aponeurotomy for the Treatment of Dupuytren's Contracture. This was the first presentation of American data showing the clear benefit of NA. All patients had a follow-up of at least 2.5 years.

Click here for the complete PowerPoint Presentation

Dr. Pess was also the guest lecturer for the San Francisco Bay Area Hand Club annual meeting In May, 2011. He presented a paper entitled, "Long Term Results of Needle Aponeurotomy for Dupuytren's Contracture - over 1,000 fingers with a minimum 3 year followup."

In April, 2012, Dr. Pess published in the Journal of Hand Surgery his study, "Results of Needle Aponeurotomy for Dupuytren Contracture". His landmark paper is available for review.

Click here to review the paper

In May 2015, Dr. Pess gave two presentations at the International Conference on Dupuytren Disease and Related Disease in Groningen, The Netherlands. "Tips and Pearls for Percutaneous Needle Fasciotomy and Collagenase – A Ten Year Personal Experience"

"Effect of Delayed Finger Extension on the Efficacy and Safety of Collagenase Clostridium Histolyticum Treatment for Dupuytren's Contracture"

In March 2016, Dr. Pess co-chaired the Dupuytren section of the combined Meeting of the American Society for Surgery of the Hand and Australian Hand Surgery Society in Sydney, NSW, Australia. He also gave a presentation "The Needle - Use it to Cut or Inject?"

Dr. Pess just published a chapter titled "Minimally Invasive Treatment of Dupuytren Contracture", in the new textbook "Minimally Invasive Surgery in Orthopedics" by Springer International Publishing

Needle Aponeurotomy Procedure

Click on one of the videos below to see a video of the Needle Aponeurotomy Procedure.

Dr. Pess

Dr. Atik

Dr. Pess

If you are interested in having NA performed by Dr. Pess or Dr. Atik at our Northeast Center for Dupuytren's Contracture, please email photos along with a brief description of your problem and a list of any past surgeries on your hand. This can be sent to one of the email addresses noted below.

Please take photos shooting down on the palm with the palm facing up. A close-up of the diseased area and a side view are also helpful. Do not send photos of the back of the hand. If you cannot email the photos, they may be sent by regular mail to our Eatontown office.

If you would like to start the scheduling process, please call Lisa directly at 732-542-4477 x206 or email her at: lisacjhs@gmail.com

If you are interested in finding out more information about Xiaflex, please go to our Xiaflex information page

Related Information

dupuytrens Preop picture of Dupuytren's contracture affecting the PIP joints of the middle and ring fingers.

dupuytrens Post-op of open fasciectomy in patient from previous photo showing contracture corrected.

dupuytrens Preop photo of significant Dupuytren's Contracture.

dupuytrens Full correction with Needle Aponeurotomy.

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