Nowadays, the therapeutic arsenal for Dupuytren's disease (DD) consists of treatments of varying degrees of invasiveness. The debate continues, particularly between percutaneous needle fasciotomy (PNF) and segmental fasciectomy (SF). It revolves around recovery times, recurrence rates and complications. Although PNF is often acclaimed for its safety, it appears to be less effective than SF in terms of recurrence. The aim of our study is to evaluate a mixed surgical technique, which consists of PNF supplemented by limited fasciectomy (PNF+LF) performed by the frequently occurring skin tear. We compared it with the conventional SF technique. Our hypothesis is that it could be a compromise between the two historical techniques, preserving the safety of PNF while reaching the efficacy to SF.

We conducted a retrospective, single-center, comparative study evaluating 69 patients treated between 2018 and 2019 by PNF+LF (31 patients) or SF (38 patients). Both groups were comparable in terms of age, sex, severity of DD and diathesis scores. Clinical evaluation was based on measurement of digital extension gain, recovery time, need for physiotherapy, satisfaction, Quick DASH and URAM functional scores, recurrence rate and complications.

At a mean follow-up of 49.8 months (about 4 years), there were no significant difference between the 2 groups regarding the total digital extension gain, satisfaction rate, and functional scores. However, the SF group had significantly longer recovery time and bigger need for physiotherapy. The recurrence rate was 50% in SF group and 19.4% in PNF+LF group. Complications occurred 8 times in the SF group (4 nervous, 4 cutaneous) and 3 times in PNF+LF (3 cases of hypoesthesia).

The technical points specific to this method were as follows: PNF was performed with a pink needle every 5mm. There was no skin incision. The fasciectomy was performed minimally through the skin tear, without deep sectioning or dissection. There were no skin sutures. Self-education was started immediately. Results of PNF+LF look similar to those of other surgical techniques of DD reported in the literature in terms of gain of digital extension, including disappointing results for PIP joint. However, recurrence rate of this technique appears to be lower than series evaluating PNF alone in the medium term and its safety is similar.

This technique of PNF+LF may represent a compromise between PNF alone and SF techniques. Its results encourage us to continue our investigations in the long term, with a larger number of patients, and on a prospective basis.