Intended for healthcare professionals

Clinical Review

Dupuytren's contracture unfolded

BMJ 2006; 332 doi: (Published 16 February 2006) Cite this as: BMJ 2006;332:397

A NICE Paris Alternative

I was interested to read the clinical review of Dupuytren’s
contracture by Townley et al. I was surprised that only passing mention
was made of needle fasciotomy which replaces a short outpatient treatment
for inpatient treatment. NICE guidelines on this procedure indicate that
it is as safe and effective as conventional fasciotomy but more likely to
recur. (1)

The perspective of the patient was missing from both the NICE
guidelines and this review. I am still working and have particularly
aggressive form of Dupuytren’s in both hands. I decided, as many others
from the UK, not to have in patient surgery, but to have a 20-minute
outpatient procedure in Paris. Even though my contracture recurs, I would
still prefer to have a needle fasciotomy every 6 months, with immediate
use of my hand afterwards and losing one days work, instead of a 6-month
recovery from surgery, with still a 60 % likelihood of recurrence.

A search of the internet would have identified many sites where
people with Dupuytren’s advise others how to avoid conventional surgery
for needle fasciotomy. Clinical Reviews and NICE should take this into
their perspective. The NICE guidelines nor this review did not mention the
difference in costs, the low complication rate (1%) and only a passing
reference to the fact that patients might prefer to avoid admission and
surgery. NICE has produced a leaflet for patients so that they can make a
choice of whether to have needle fasciotomy or open hand surgery.

But there is no choice. As far as I know there is no one in the UK
doing needle fasciotomy, using the techniques developed in Paris.

Christine Hogg

1 National Institute of Clinical Excellence, 2004, IPG043 Needle
fasciotomy for Dupuytrens contracture, guidance

Competing interests:
None declared

Competing interests: No competing interests

18 February 2006
Christine Hogg
Oxford OX4 1TG