Needle Aponeurotomy

Needle Aponeurotomy (NA) or Percutaneous Needle Fasciotomy (PNF) is an outpatient surgical procedure that became popular in France more than 20 years ago, and since then has been used in other countries as well.

Our doctors and clinics page lists some UK surgeons who have experience treating Dupuytren’s with PNF.

In May 2019 we organised a webinar on PNF with international experts speaking on the subject. You can watch the webinar on YouTube.

The aim of NA is to straighten contracted fingers with minimal side-effects and (with the help of physiotherapy if necessary) achieve a functional finger and hand again.

In order to do this safely and effectively, there has to be a palpable cord and some contracture of the finger. As Mr C Bainbridge, senior surgeon at the Puvertaft Hand Centre in Derby explains: NA depends on a bent finger to allow the ends of the cord to separate as the finger straightens. Also the tightness of the cord by producing laxity of the digital nerves and artery protects them from damage.

A needle fasciotomy is often the standard treatment for mild Dupuytren’s contracture, although some surgeons prefer to perform surgery as the results of actually removing the tissue rather than just cutting it tend to last longer. The procedure is sometimes also known as a Needle Aponeurotomy, or a Percutaneous Needle Fasciotomy (PNF) (percutaneous means ‘done through the skin’).

A needle fasciotomy is usually performed as an outpatient procedure. This means that you will not need to be admitted to hospital. You will be given a local anaesthetic that will numb your hand without making you lose consciousness.

During the surgery, a very fine needle will be inserted into the fibrous bands (the cords) in either your palm or your fingers. This will be used to slice through the cord and divide it up under your skin. After cutting through the thickened tissue, your surgeon will then bend your finger back to snap and release the tightness that was forcing your finger into the contracted position. An aftercare leaflet can be found here.

The benefits of needle fasciotomy include:

1/ A reduction in the deformity in your fingers

2/ A faster recovery compared with more extensive surgery

3/ It is suitable for people who are unable to have more extensive surgery, such as the very frail or elderly

4/ It has a low risk (around 1%) of complications

The rate of reccurrence for Dupuytren’s contracture is very high. As many as 50% of people who have a needle fasciotomy will have Dupuytren’s contracture again in the same finger within 3-5 years. Often the needle fasciotomy can then be repeated again.

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on this procedure.

We have a special YouTube channel for our webinars and videos. Here specialists explain more about the different treatment options and the rationale behind them, as well as what might be possible in the future.    The channel can be found here:

British Dupuytren’s Society YouTube channel

The videos we have done are:

1/ Dupuytren’s disease and surgical treatments

2/ Percutaneous needle fasciotomy for Dupuytren’s

3/ Dupuytren’s Research updates

4/ Ledderhose Disease

5/ Radiotherapy for Dupuytren’s and Ledderhose

6/  A video on surgical options for Peyronie’s Disease

7/ Four shorter videos that offer help with ‘resilience’, how to cope when you’ve been diagnosed and it all feels very overwhelming. 4

For more information on PNF on the NHS, this pdf gives the text of the relevant talk from our webinar. Anna Schurer PNF- NHS talk

Our doctors and clinics page lists some UK surgeons who have experience treating Dupuytren’s with PNF.

Patient experience

A patient describes his experience of PNF here with some before and after photographs.

A patient recorded his own treatment and put the video on YouTube.

Examples with before and after photos are available on our partner site.

For the non-squeamish, we show a link to a video of this treatment here.