Percutaneous needle fasciotomy

Office-based percutaneous division of the Dupuytren cord with a small-bore (typically 25-gauge) needle under skin-wheal local anaesthesia, indicated for palpable pretendinous-cord contracture in selected primary disease. Reintroduced in the late 1970s by the French rheumatologist Lermusiaux. Shorter recovery and higher recurrence than limited fasciectomy.

Related terms

• Procedure

  Limited fasciectomy

  Open surgical excision of the diseased palmar and digital fascia through a Bruner-zigzag or longitudinal-Z-plasty incision, with preservation of normal fibres. The contemporary operative workhorse for Dupuytren's contracture. Lower five-year recurrence than percutaneous needle fasciotomy at the cost of greater up-front morbidity, longer recovery, and a higher rate of nerve and vessel injury.

• Procedure

  Dermofasciectomy

  Operative excision of the diseased palmar fascia together with the overlying skin, with reconstruction by full-thickness skin graft. Reserved for recurrent disease and for primary surgery in the strongly diathetic patient. Reduces recurrence on the rationale that diseased fascia regenerates beneath unaffected skin but is markedly less likely to do so beneath a graft.

• Treatment

  WALANT

  Wide Awake Local Anaesthesia No Tourniquet — operative technique using lignocaine with adrenaline as the sole anaesthetic, without proximal tourniquet, allowing the patient to actively participate in operative testing. Established for primary fasciectomy by Denkler 2005 and the Lalonde-led 2010 multicentre series.

• Condition

  Dupuytren's disease

  Benign progressive fibroproliferative disorder of the palmar and digital fascia, classified by WHO 2020 as a palmar-type fibromatosis. Characterised by myofibroblast-driven formation of nodules and cords in the palmar aponeurosis, leading to progressive flexion contracture of the digits, most commonly the ring and little fingers.

• Anatomy

  Digital neurovascular bundle

  Bundle containing the proper digital artery, proper digital nerve, and accompanying veins, running along the radial and ulnar aspects of each finger, deep to Grayson's ligament and superficial to Cleland's ligament. Its position is normally predictable but is displaced by the spiral cord in Dupuytren's disease.

• Anatomy

  Spiral cord

  Pathological cord formed by the confluence of the pretendinous band, spiral band, lateral digital sheet, and Grayson's ligament. Displaces the digital neurovascular bundle palmarly, centrally toward the digital midline, and proximally — most marked at the level of the proximal phalanx. The principal anatomical reason needle fasciotomy is contraindicated for established proximal interphalangeal contracture.

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