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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Advanced Techniques in Percutaneous Needle Fasciotomy and Collagenase – Going Beyond the MP Joint

Meeting Abstract

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  • presenting/speaker Gary Pess - CJHS, Wayside, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-79

doi: 10.3205/19ifssh0428, urn:nbn:de:0183-19ifssh04289

Published: February 6, 2020

© 2020 Pess.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation:

1.
Learn to apply the advanced techniques discussed to perform PNF and Collagenase on patients with severe Dupuytren Contracture.
2.
Analyze contractures to predict the location of cords.
3.
Assess a hand and formulate a plan to release severe contractures
4.
Diagnose hidden cords that need to be released to achieve correction of the contracture

Methods: Percutaneous needle fasciotomy (PNF / NA) and Collagenase are newer minimally invasive techniques used to treat Dupuytren Contracture. Most Hand Surgeons are confident in using one of the two procedures for mild MP joint contractures. However, many surgeons do not feel it is safe to utilize either treatment for PIP joint contractures or combined MP and PIP joint contractures. Patients with severe contractures are often only offered open fasciectomy for treatment.

This presentation will demonstrate specific techniques that can be applied to perform PNF and Collagenase on patients with severe Dupuytren contracture. Attendees will be able to assess a hand and formulate a plan to release the severe contractures.

The surface and deep anatomy of Dupuytren cords and the neurovascular bundles will be reviewed. Contractures will be analyzed so that the location of cords causing the contracture can be predicted and then treated. Advanced tips and pearls for PNF and Collagenase will be discussed, including the diagnosis of hidden cords that need to be released to achieve full correction of the contracture. Step by step instructions for correction of severe contractures will be illustrated through the presentation of the most difficult cases.

Results and Conclusions: Experience performing over 7,000 PNF and 1,000 Collagenase procedures has revealed that severe Dupuytren contracture can be released successfully using minimally invasive techniques. It is important for doctors to learn these advanced techniques so minimally invasive alternatives for the treatment of severe Dupuytren contracture can be offered.