Needle Fasciotomy (Percutaneous Needle Fasciotomy=PNF)

In contrast to hand surgery procedures, needle fasciotomy is a minimally invasive procedure with a fast healing time and short follow-up time.In this procedure, the connective tissue strands are weakened by needle stitches to such an extent that they can be stretched and torn manually. In most cases, this method of treating Dupuytren’s disease is performed on an outpatient basis with a mild local anaesthetic. The advantage of this procedure is a very small scarring on the skin, since it is only punctured by small needles, and a very short healing time.

Often the hand is functional again after only a few days. In addition, the therapy is only slightly painful and can be used repeatedly in case of recurrence. In most cases, needle fasciotomy is used in the early stages as soon as the first signs of an extension deficit appear.

If surgery is not possible for other reasons, needle fasciotomy can also be successful in stage IV. Since contractures are very pronounced in this stage, it is often not possible to achieve complete restoration of hand function. However, in many cases a significant improvement of the situation can be achieved.

In general, although the recurrence rate is higher with this form of therapy than with surgical therapy, the minor intervention and the fast and complication-free healing time are an important aspect of needle fasciotomy. Moreover, this form of therapy can be used repeatedly. To minimize the risk of recurrence, wearing a night splint for several months after the procedure is recommended. This keeps the fingers in an extended position to avoid the bending contracture. How long and whether the splint must be worn varies from individual to individual and should be discussed with the treating physician.

Enzyme injection with collagenase

The connective tissue strands responsible for contractures consist mainly of collagen. In the meantime, an enzyme has been developed, collagenase, which breaks down these strands. This enzyme is injected into the Dupuytren strand and has to act for about one day.

Afterwards, the strands are torn apart manually as in needle fasciotomy. Since the development of this enzyme is still relatively new, there are no long-term studies available to assess the therapeutic results of Dupuytren’s disease. In Germany, the drug has been withdrawn from the market again for cost reasons, as it does not yet show clear advantages over other therapies for Dupuytren’s disease.

In other countries, collagenase is still used and is considered promising. There are also no studies on possible side effects. The most frequently reported acute side effects were local allergic reactions at the injection site.

These occurred as edema, dark, blister-like bulges on the skin, bruising and bleeding. In general, these symptoms were mild and subsided after one to two weeks in the trials. Itching and pain in the hand were also frequently observed.