IPG043 Needle fasciotomy for Dupuyren's contracture - guidance

NHSIssue date: February 2004National Institute forClinical ExcellenceNeedle fasciotomy for Dupuytren’s contracture1 Guidance1.1 Current evidence on the safety and efficacyof needle fasciotomy for Dupuytren’scontracture appears adequate to support theuse of the procedure, provided that normalarrangements are in place for consent, auditand clinical governance.2 The procedure2.1 Indications2.1.1 Dupuytren’s contracture is a benign, slowlyprogressive condition of unknown origin. Thedisease is characterised by a thickening of theconnective tissue in the palm of the hand,leading to difficulties in extending thefingers.2.1.2 Most individuals with Dupuytren’scontracture are affected in both hands. Themost commonly involved digit is the ringfinger, followed by the little finger and thenthe middle finger.2.1.3 Treatment seeks to restore hand function andprevent progression, because the underlyingdisease will remain. Both surgical and nonsurgicaloptions exist. Data are lacking on theeffectiveness of most non-surgical treatmentsfor Dupuytren’s contracture, such as vitamin Ecream and ultrasonic therapy.2.2 Outline of the procedure2.2.1 Needle fasciotomy is an outpatient procedurein which one or more fibrous bands(contractures) are divided using a blade or thebevel of a needle. The procedure can beperformed in either the palm or the fingers.2.3 Efficacy2.3.1 On the basis of the evidence, the main benefitoffered by this procedure is a short-termreduction in the degree of contracture.Recurrence rate is approximately 50% at3–5 years and seems to depend on the severityof the disease. Some data also suggest thatindividuals with less severe disease and/or withmetacarpophalangeal joint contracturebenefited most from this procedure. For moredetails, refer to the Sources of evidence (seebelow).2.3.2 One Specialist Advisor commented thatalthough the procedure was not as efficaciousin the long term as open surgery, patientsexperienced less morbidity and had fasterrecovery.Interventional Procedure Guidance 43This guidance is written in the following context:This guidance represents the view of the Institute which was arrived at after careful consideration of the available evidence.Health professionals are expected to take it fully into account when exercising their clinical judgement. This guidance doesnot, however, override the individual responsibility of health professionals to make appropriate decisions in thecircumstances of the individual patient, in consultation with the patient and/or guardian or carer.Interventional procedures guidance is for health professionals and people using the NHS in England, Wales and Scotland.