A Patient Guide

Dupuytren's contracture affects the palmar fascia, a reinforcing mesh which lies just beneath the skin of the palm. Needle Aponeurotomy is a minimally invasion treatment for Dupuytren's Contracture. This handout explains the procedure.

Before the procedure

  1. Food: Unlike traditional surgery, it is safe to eat before the procedure.
  2. Medication:
    1. If you are concerned about being anxious, or have had to take anti-anxiety medicine in the past for dental procedures, its reasonable to take anti-anxiety medication such as Valium or Xanax before this procedure. Please notify us if you think you may need an anti-anxiety medication.
    2. If your regular doctor has recommended that you take prophylactic antibiotics before surgery because of a joint replacement, heart disease or other medical problems, it is appropriate to take that type of medicine before this procedure. You will need to notify your regular physician to obtain a prescription.
    3. If you take aspirin, vitamin E or blood thinners such as Coumadin, or have any questions about your medications, please check with our staff prior to your appointment.
  3. Skin Problems: If you have recent injuries, wounds, insect bites or healing areas involving the palm of the hand or the fingers, it might not be safe to proceed with needle aponeurotomy because of the risk of infection. Please notify our staff if you have any wounds or infections.

Common questions about the procedure

  1. What is actually done during the procedure? The procedure is performed while you lie down on your back with your arm stretched out. Dr. Stuart will use a marking pen to mark the skin where he plans to use the needle. He will then numb the skin at these sites with a tiny needle and local anesthetic. Once numb, he will work with a needle to cut the cords under the skin and reduce the contracture.
  2. What should I do during the procedure? Relax, listen to music and talk as much as you like. The actual procedure is only intermittently uncomfortable. You will need to tell Dr. Stuart if you feel anything painful and, in particular, if you feel any tingling or numbness in your fingertips.
  3. Is it very painful? Usually not. The injections into the skin sting for a few seconds but become numb very quickly. The cords don't hurt when they are cut. Joints that have been very bent may be painful to stretch out but it subsides quickly.
  4. What will my hand look like after the procedure is over? If all goes well, your fingers should be straighter. The needle entry sites will be covered with bandaids. Ice will be placed on your hand immediately after to prevent swelling and soreness.

Early Aftercare

  1. Day of Procedure
    1. Bandaids can usually be removed and left off later the same day. If you get them wet, remove them and leave them off.
    2. Use: You should be able to use your hand for light activities (eating, getting dressed, and hygiene). You will be able to get it wet in the shower or when washing your hands.
    3. Splinting your hand with a custom brace may be indicated if you have several fingers involved or severe contractures; if it is, Dr. Stuart will have ordered a splint for you prior to leaving after the visit. Otherwise, splinting is seldom needed.
  2. First 48 hours
    1. Ice and elevation are the keys to a painless recovery. On the day of and day after the procedure, keep your hand elevated as much as you can; and use ice or hold something cold every hour for 10 minutes at a time. Avoid swimming or soaking your hand at this time where the hand is submerged for a long period of time.
    2. Washing: You should try to keep your hands dry for a few hours after the procedure.
  3. The First Week
    1. You should avoid strenuous activities with the hand for one week after the procedure. During this time, avoid activities which would make your hands sweaty, grimy, dirty or exposed to harsh chemicals. This is veryimportant to prevent infection.
    2. Medications: Usually there is no need for prescription pain medicine after the procedure. You may use over the counter acetaminophen or ibuprofen as needed.

Follow up

Dr. Stuart's staff will arrange a follow up appointment for you a few weeks after the procedure.