Kees’ story – Needle Release

The following patient experience is for Needle Aponeurotomy (NA) also called Percutaneous Needle Fasciotomy (PNF), to treat contracture of the little finger about the MCP joint, by cutting through cords in the palm. It has been provided courtesy of Anna Schurer a BDS Trustee and the patient is her father. The treatment was done in the Netherlands, at the St Antonius Ziekenhuis, by Ms Braakenburg a hand and wrist plastic surgeon.

Pre-operation photographs:

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As he told to me over the phone:

The surgeon worked nicely on time. She filled a large syringe with a local anaesthetic preparation and put a clean needle on it.

She then inserted the needle through the skin into the first of two cords that were to be treated and injected a bit of the local anaesthetic in the cord. This part was a bit painful but the area was numbed quickly. With the same needle and without taking it out she started moving the tip around in the cord to disrupt the tissue and break the cord.

After she had treated the two obvious cords this way she examined my hand again, and said: I feel another one here, shall I treat that as well for you?

And after treating number three she found a fourth cord, and gave that one the same treatment. Altogether four cords were treated, two gave way directly and for the other two she straightened my fingers and I felt it snap. By this time my hand was quite numb, so I did not feel any pain.

She could not straighten my little finger completely as there was a plaque of Dupuytren’s tissue in that, and PNF in a finger is not safe because the nerves and blood vessels are too close to the plaque, so if I wanted that treating then surgical removal would be the only option (BDS note: in this specific case Xiapex is not deemed to be an option).

The surgeon applied a bandage to my hand, and told me to remove it the next day, and put a simple plaster on if I could still see the punctures by then. I had to start pressing my hand and fingers straight directly and could work in the garden again after 2 days. She did not recommend driving home, although she said many people did it anyway.

She also explained that in young people this method gives a high risk of recurrence within a few years, but at my age( 81 years young) the disease tends to be a lot slower and I may never need that hand treating again. I can phone her secretary in 2-3 months time to make an appointment to have my other hand treated.

Post-operation photographs:

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Altogether it was a simple and effective treatment, took about 20 minutes and my hand is a lot straighter than before. I am glad to have had this treatment and not the full surgery, and would have this done again if necessary.