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What is the history of Needle Aponeurotomy?

Needle Aponeurotomy is a new twist on the old procedure of percutaneous fasciotomy. In fact, percutaneous fasciotomy was probably the first surgical procedure ever reported for the treatment of Dupuytren's contracture - before it was even called Dupuytren's. In 1822, prior to Dupuytren's 1831 presentation of open fasciotomy, the renowned British surgeon, Sir Astley Cooper wrote "The fingers are sometimes contracted ... when the aponeurosis is the cause of the contraction, and the contracted band is narrow, it may be with advantage be divided by a pointed bistoury, introduced through a very small wound in the integument. The finger is then extended, and a splint is applied...". Translating aponeurosis=fascia, bistoury=knife, integument=skin, this is clearly a description of percutaneous fasciotomy for what later came to be called Dupuytren's contracture.

In the nineteen hundreds, percutaneous fasciotomy fell out of favor as a surgical procedure, and is mentioned only briefly in current surgical texts. The reasons for this are unclear, but probably reflects the strong trend toward fasciectomy (surgical removal of the contracted cord) over fasciotomy (simple release of the cord) in the last century. Available literature does not strongly document a clear superiority of fasciectomy over fasciotomy, and surgical practice may simply reflect convention rather than consideration, as is the case for many surgical procedures.

About thirty years ago, the French rheumatologist, Dr. Jean-Luc Lermusiaux , first performed a percutaneous fasciotomy for Dupuytren's using a 25 gauge needle, with such dramatic success that he recalls that "...the patient was so happy, she jumped up and kissed me". He is currently part of a group of Paris rheumatologists who perform many thousands of needle aponeurotomy procedures each year. The use of a small needle instead of a scalpel was a small but critical modification of the percutaneous fasciotomy technique which reduces both inflammation and recovery time compared to traditional surgery.

 
In 2003, the American hand surgeon Dr. Charles Eaton visited the Paris group and brought the procedure back to the United States. Already skilled in traditional Dupuytren's surgery, Dr. Eaton applied his knowledge and experience as a hand surgeon to refine and standardize this technique, referred to as the Eaton Method of Needle Aponeurotomy.  Dr.Eaton has been educating other hand surgeons in this technique since 2006, and lectures nationally on the topic. He has compiled an exhaustive compendium of information on Dupuytren's for both patients and physicians and is truly revolutionizing Dupuytren's care in this country. To learn more about Dr.Eaton's practice please click here.

 
Last updated 10.6.08

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