1. Symposium 2 Needle Aponeurotomy for the Treatment of Dupuytren’s Contracture A Prospective Study Gary M. Pess, MD Central Jersey Hand Surgery Eatontown, NJ Nothing of financial value to disclose

2. Needle Aponeurotomy for the Treatment of Dupuytren’s Contracture A Prospective Study Gary M. Pess, MD Central Jersey Hand Surgery Eatontown, NJ

3. Why Reconsider Fasciotomy? Gary M. Pess M.D. High recurrence rate with open surgery High recurrence rate with open surgery Recovery can be prolonged Recovery can be prolonged Some patients never regain full flexion Some patients never regain full flexion Significant surgical complication rate Significant surgical complication rate

4. Hand Surgeons Are Perfectionists! Gary M. Pess M.D. But can we really cure Dupuytren’s Contracture?

5. Needle Aponeurotomy Technique Gary M. Pess M.D. Outpatient procedure – office or surgery center Outpatient procedure – office or surgery center Local anesthesia (rarely MAC) Local anesthesia (rarely MAC) No tourniquet necessary No tourniquet necessary Five cc syringe Five cc syringe 1 cc DepoMedrol + 3 cc Xylocaine 1% plain 1 cc DepoMedrol + 3 cc Xylocaine 1% plain Short 25 gauge 5/8” needles Short 25 gauge 5/8” needles

6. Needle Aponeurotomy Post Procedure Gary M. Pess M.D. Exercise fingers immediately Exercise fingers immediately Can wash hand Can wash hand No heavy grasping for 2 weeks No heavy grasping for 2 weeks Night splint for 3 months Night splint for 3 months Therapy for stiff fingers and residual contracture Therapy for stiff fingers and residual contracture

7. Needle Aponeurotomy Materials and Methods 128 Patients 128 Patients 260 Fingers 260 Fingers Male : Female - 4 : 1 Male : Female - 4 : 1 Average age: 61 Average age: 61 Gary M. Pess M.D. Gary M. Pess M.D.

8. Needle Aponeurotomy Materials and Methods DIGITPercentNumber Thumb Thumb1%2 Index Index5%12 Middle Middle15%40 Ring Ring37%96 Little Little42%110 JOINT MP MP68%225 PIP PIP32%136 Gary M. Pess M.D.

9. Needle Aponeurotomy Materials and Methods Only one procedure per finger Only one procedure per finger Two patients deceased Two patients deceased Twelve patients lost to follow-up Twelve patients lost to follow-up Minimum follow-up 2.5 years (Range 2.5 - 3.5 years) Minimum follow-up 2.5 years (Range 2.5 - 3.5 years) Gary M. Pess M.D.

10. Results MP Joint Gary M. Pess M.D.

11. Results PIP Joint Gary M. Pess M.D.

12. Results Percent Correction Gary M. Pess M.D. P<.001

13. Results by Digit MP Joint Final Correction Gary M. Pess M.D.

14. Results by Digit PIP Joint Final Correction Gary M. Pess M.D.

15. Results by Age Final Correction Gary M. Pess M.D. P<.001

16. Results by Gender Final Correction Gary M. Pess M.D.

17. Results Success in Correcting <= 5º Gary M. Pess M.D. MP Joint: 97% fingers MP Joint: 97% fingers PIP Joint: 70% fingers PIP Joint: 70% fingers

18. Results Joint Recurrence > 20º Gary M. Pess M.D. MP Joint: 14% fingers MP Joint: 14% fingers PIP Joint: 54% fingers PIP Joint: 54% fingers

19. Results Final Improvement >=50% Gary M. Pess M.D. MP Joint: 81% MP Joint: 81% PIP Joint: 50% PIP Joint: 50%

20. Results Complications Gary M. Pess M.D. Skin tear: 1.9% (5) – All healed Skin tear: 1.9% (5) – All healed Temporary Neurapraxia: 1.2% (3) Temporary Neurapraxia: 1.2% (3) Tendon or Pulley Rupture: 0% Tendon or Pulley Rupture: 0% Nerve Laceration: 0% Nerve Laceration: 0% Arterial Laceration: 0% Arterial Laceration: 0% Hematoma: 0% Hematoma: 0% Infection: 0% Infection: 0% RSD: 0% RSD: 0% Hospitalization: 0% Hospitalization: 0%

21. Conclusions Needle Aponeurotomy Gary M. Pess M.D. Statistically significance difference: MP v. PIP (p<.001) Statistically significance difference: MP v. PIP (p<.001) Statistically significance difference: 50 (p 50 (p<.001) No difference based on gender or digit affected No difference based on gender or digit affected Correction of contracture <=5º Correction of contracture <=5º –MP Joint: 97% –PIP Joint: 70%

22. Conclusions Needle Aponeurotomy Gary M. Pess M.D. Final Result MP Joint PIP Joint Recurrence > 20º 14%54% Improvement >= 50% 81%50%

23. Conclusions Needle Aponeurotomy Gary M. Pess M.D. Needle Aponeurotomy is a safe procedure Needle Aponeurotomy is a safe procedure Complication rate lower than fasciectomy Complication rate lower than fasciectomy Can be performed in an office setting Can be performed in an office setting High patient satisfaction High patient satisfaction Excellent procedure for Dupuytren’s Contracture Excellent procedure for Dupuytren’s Contracture

24. Surgical Goal Gary M. Pess M.D.

25. Thank You! Gary M. Pess M.D.