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The e-mémoires of the Académie Nationale de Chirurgie

Minimally Invasive Treatment in Dupuytren’s Desease

JALAGUIER T | GAZARIAN A

Seance of wednesday 13 march 2019 (Séance interventionnelle : traitement percutané des lésions de la main et du poignet)

Abstract

Introduction: The aim of the study is to evaluate minimally invasive treatment in Dupuytren's disease and to compare the results with our series of 10 consecutive patients treated by the gold standard surgical treatment, fasciectomy, with a follow up of 10 years.
Methods: Two minimally invasive methods used in Dupuytren's disease: percutaneous needle aponeurotomy (PNA) and collagenase injection (CI) have a review of the literature by articles who respect the criteria: absence of conflicts of interest, exhaustive description of the technique used, definition of recurrences and complications.
The clinical results of single-center series of 10 consecutive patients who had fasciectomy (F) on one finger or more with 10 years follow-up were used for comparison.
Results: PNA can be performed in an office, allowing to go from a mean contracture MCP of 38 ° to 10 ° at 3.2 years for one of the studies with recurrence at 58% and only one complication (neuroma). 20% had a second PNA or F.
CI is also easy to carry out in the office. The French High Authority of Health has issued an unfavorable opinion for its reimbursement. An IC versus PNA study with a 2-year follow-up shows superior efficacy of AA for IP and similar results for MCP (IC: contracture MCP 38 °, IP 60 ° in pre-injection at 6.5 ° and 41° respectively at 2 years; PNA contracture of MCP 45 °, IP 51 ° at respectively 4 ° and 6.5 ° at 2 years).
For our personal series, 10 patients (12 fingers) were reviewed. An iatrogenic lesion of a collateral nerve was repaired intraoperatively. The preoperative contracture MCP and IP were respectively 30 ° (0 ° -75 °) and 36.6 (0 ° -70 °). At final follow-up, the contracture MCP and IP were respectively 11.9 ° (0 ° -10 °) and 40.9 ° (0 ° -90 °). At this time 6 patients presented a recurrence of the disease and 5 were operated again by F.
Discussion: PNA, appreciated by most patients, has the advantage of being easy to perform in the office. Its use in digital forms presents a theoretical iatrogenic risk on the collateral pedicles. PNA is of interest in terms of health economy with a short recovery time and a lower cost of realization.
CI looks promising, but there are no studies evaluating their efficacy and long-term safety. Many authors contraindicate their use in digital forms and find the cost less important than F.
Conclusion: Minimally invasive techniques in Dupuytren's disease are of real interest for certain patients and certain disease forms, as is health economics.