MINIMALLY INVASIVE NEEDLE APONEUROTOMY IN THE TREATMENT OF PATIENTS WITH DUPUYTREN'S CONTRACTURE

The problem of treatment of patients with Dupuytren's contracture keeps its urgency in connection with the high prevalence of this medical problem - about 3% of population of different countries and 11.8% among all registered hand diseases. The progressive disease leads to significant disorder of hand performance, restricted fine professional activity in 67% of patients, and to disability in 3% of patients. Вопросы реконструктивной и пластической хирургии № 3 (62) сентябрь’2017 34 Жигало А.В., Почтенко В.В., Морозов В.В., Стадниченко С.Ю. Aim of the study: to improve the results and to shorten the time of treatment of patients with Dupuytren's contracture through development and practical implementation of a novel minimally invasive technique. Material and methods. We have developed and implemented (since 2008) the new minimally invasive technique for treatment of Dupuytren's contracture - needle aponeurotomy. It consists essentially in transdermal transection of cords of diseased palmar aponeurosis at several levels from small skin perforations by needles of different diameter under regional infiltration anesthesia and injection of collagenase products or steroid hormones into a large node of palmar aponeurosis. The study consisted of two parts: topographic-anatomy and clinical. The topographic-anatomy part was performed at 46 upper extremities and 24 dead bodies. In this part, the following aspects have been studied: possibility of transection of palmar aponeurosis by needles of different diameter, techniques of aponeurosis intersection by needles, optimal accesses to palmar aponeurosis for needle aponeurotomy. In the clinical part, the results of treatment of 1297 patients with Dupuytren's contracture aged from 24 to 83, who underwent 2127 needle aponeurotomies in the period from 2008 to 2017, have been analyzed. Results. The results of treatment were evaluated by the qDASH scale. Excellent results were obtained in 56.4% of all cases, good results - in 28.1% of cases, satisfactory - in 10.4% of cases, and unsatisfactory - in 5.1% of cases. Recurrences were observed in 45% of patients for 5 years after the needle aponeurotomy. The hospital time was, on average, 1.5 hour and included consultation, Doppler sonography, surgery, and follow-up care. Then the patients were treated on outpatient basis (course of physical therapy, exercise therapy). In the absence of complications, the patients were allowed using the hand in everyday life immediately after the surgery. Conclusions. The main advantage of needle aponeurotomy is its low surgical injury, which has allowed the surgery to be performed on the same-day basis, even at two hands at a time. In this case, the patient practically is not disabled and can return to work at the next day after the surgery. Another positive aspect is the minimal risk of complications even in elderly and senile patients with serious comorbidity. At the same time, the method has one significant disadvantage, namely, the high rate of recurrence in comparison with subtotal aponeurotomy. Therefore, we believe that the needle aponeurotomy is an operation of choice for elderly and senile patients and patients with serious comorbidity and counter-indications to open surgery and/or general anesthesia. In addition, we recommend it as a preparatory stage of surgery in young patients with severe disease before subtotal aponeurotomy.

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