Needle fasciotomy, needle aponeurotomy (NA) for Dupuytren's Contracture is a technique that dates back to Dupuytren and his earlier English colleagues Cline and Astley Cooper. Dr. Denkler trained with the French doctors in Paris, France that developed this techniuqe. The French needle techniuqe uses small hypodermic needles to poke into the skin and then transect the fibrous cords of Dupuytren's contracture with a back and forth cutting motion. Multiple areas are cut in order to break up the cords into many segments. It is an office technique using local anesthesia and without a need for a surgicenter or anesthesia costs. This technique is covered by Medicare and possibly other insurance companies using CPT procedure code 26040 per digit, and a diagnosis code of 728.6 for Dupuytren's. Occassionally, joint and tendon releases (CPTcode 26060) are also necessary to fully release the contracted proximal interphalangeal joint (PIP or middle joint).
Postoperative care is a bulky soft dressing that stays in place for one or two days, then it may be removed. After two days, a shower is OK and the small punctures may be covered with antibiotic ointment and sterile guaze or band-aids.
Pain medicine sometimes is required in the first few days especially if there is excessive scar from previous surgeries or joint releases are necessary. The effects of the local anesthetic will last from 12-24 hours. Localized numbness of the finger is common due to swelling in the first few weeks.  Nerve injury is 1%.  Most nerve injuries are partial loss of feeling to one side of the finiger.  Recovery can take 3-6 months.  The most dangerous area for nerve injury is in recurrent disease after previous open surgery, especially around the PIP joint.  Formal physical therapy is not usually required for first joint disease.  Disease of the middle joint may often need physical therapy assistance for splinting.   Frequent stretching of the hand at home is required in the first month or two. Occassionaly, spring splints are necessary for patients with more severe contractures of the PIP joint.  For those patients with greater than 45 degrees of PIP joint contracture or have had previous surgery, physical therapy is necessary to prevent recurrence of joint contractures as the muscles that straighten the PIP joint are weak due to the longstanding contracture and therapy is necessary to strengthen them.
Improvement in extension at the first joint (MCP) is usually rapid. Middle joint improvement in extension may require stretching or splinting for a prolonged period.
Final results may be seen after 2-3 months. The first joint will usually correct fully or nearly so in virgin Dupuytren's patients. Middle joint function often shows only partial, or about 50% improvement due to the unique character of this joint even though there may be complete correction at surgery. The muscles that extend this joint are inherently weak and are weakened more by longstanding contractures. It is difficult to strengthen them 100% before the contractue becomes fixed again.
Recurrence of the disease does occur, since the disease is not cured, only the cords are severed to allow extension. Daily stretching is necessary long term to help prevent recurrent contracture.
Needle aponeurotomy or needle fasciotomy may be repeated and it does not inhibit open surgery at a future date if necessary.