Dupuytren's finger splints, paraffin baths, and coban wraps for edema and swelling


 
 




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Keith Denkler, M.D.


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Keith Denkler M.D.  
Plastic and Reconstructive Surgery  
415-924-6010  
275 Magnolia Ave.  
www.PlasticSurgerySF.com  
Larkspur, CA 94939  


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Patient Information for Dupuytrens Contracture
Needle fasciotomy or needle aponeurotomy (NA) for Dupuytren's Contracture is a technique that dates back to Dupuytren and his earlier English colleagues, Cline and Astley Cooper. The technique of needle aponeurotmy ( needle aponevrotomy in French) was developed by Dr. Lermusiaux in Paris, France in the 1970s. Dr. Denkler trained with the Dr. Lermusiaux the originator of this alternative to Dupuytren's surgery. The French needle technique uses small hypodermic needles to poke into the skin and transect the fibrous cords of Dupuytren's contracture with a back and forth,up and down using cutting and transecting motions. Multiple perforations in the cord are developed in order to break it up into multiple segments. It is an office technique using local anesthesia and without a need for surgicenter or anesthesia costs. This technique is covered by Medicare (except for deductibles, copays, or regulations), and other insurance companies using CPT procedure code 26040 per digit, and a diagnosis code of 728.6 for Dupuytren's. Joint and tendon releases are also sometimes necessary to fully release the contracted proximal interphalangeal joint (PIP or middle joint). Results after release of PIP contractures are not as good as the results after MCP joint release (first joint near palm). 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, sterile gauze, 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 less than 1%. Most nerve injuries are partial loss of feeling to one side of the finger. 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. Occasionally, 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.<BR>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 contracture 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 or subsequent use of the dissolving enzyme, Xiaflex, made by Auxilium Pharmaceuticals. After needle release, the nodules and cords can harden and thicken. A variety of products can aid the reduction of swelling and improvement in motion after needle fasciotomy.

Coban wraps may be used during the day and night to squeeze out swelling and edema of the tissues caused by the needle technique:

Night finger splints and other finger splints can be found online with Amazon.com:

Paraffin wax baths are excellent for the hands to create deep heating and loosen up the tissues for a good active stretching








Keith Denkler, M.D.  |  Contact Info  |  Common Procedures  |  BOTOX® for Wrinkles  |  Dupuytren's and XIAFLEX Pictures  |  Dupuytren's Contracture (Maladie de Dupuytren)  |  Dupuytren's for Patients  |  FAQ/Needle Aponeurotomy  |  ASSH Hand Society Presentation of NA  |  AAPS Presentation on Needle Aponeurotomy for Severe Dupuytren's  |  Credentials  |  Curriculum Vitae  |  Directions/Office Hours  |  2011 ASSH Presentation Paper 20  |  Links  |  News Articles

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