Dupuytren contracture is a chronic condition characterized by flexion contractures of the digits, especially the metacarpophalangeal joint and the proximal interphalangeal joints. One-half of patients with Dupuytren contracture who undergo open surgery have single-ray involvement, and approximately 95% of patients with Dupuytren contracture who undergo open surgery have a flexion contracture no greater than 135°. These correspond with Tubiana stage 1 through stage 3 Dupuytren contracture, which are considered nonadvanced forms of Dupuytren contracture. Dupuytren contracture can be managed via percutaneous or open surgery. Established flexion contractures are mainly managed via surgical excision of the cord through a limited fasciectomy, which also is known as an aponeurectomy. Long-term postoperative recovery after limited fasciectomy has led to the use of minimally invasive techniques in the past 10 years. These minimally invasive techniques include percutaneous needle aponeurotomy and collagenase injections. Complications occur much less frequently in patients who undergo needle aponeurotomy. The most common complication of needle aponeurotomy is skin tears.

This video demonstrates ultrasonographic-guided aponeurotomy. Ultrasonographic-guided aponeurotomy is performed in an outpatient setting. The application of a tourniquet is not necessary. Ultrasonographic-guided aponeurotomy allows for release of interphalangeal contractures with direct control of the nerves and vessels. Needles of different thicknesses or a straight V-shaped curette can be used. The needle is inserted from ulnar to radial at the point selected, with the transducer in the same plane as the needle along the short axis or the axis that is transverse to the cords. With the ultrasonography device in a transverse position, multiple perforations are made from ulnar to radial and from deep to superficial at all selected points until the cord is released.

Our preliminary results of ultrasonographic-guided aponeurotomy are encouraging. Very few complications occurred (one skin tear and one case of recurrence that required additional surgery). Ultrasonography makes classic blind aponeurotomy easier, more accurate, and safer, affording surgeons direct and continuous monitoring of the neurovascular bundle. The incidence of skin tears is low because the entry portal is in a lateral area and the sweeping motion at the tip of the needle is far from the portal. Ultrasonographic-guided aponeurotomy allows for safe and effective release of interphalangeal contractures. Recurrence can be managed via the original aponeurotomy procedure, and recovery after ultrasonographic-guided aponeurotomy is rapid, with minimal morbidity. Ultrasonographic-guided aponeurotomy for the management of single- or three-ray Dupuytren contracture may decrease treatment costs. Ultrasonographic-guided aponeurotomy may become the preferred method for the management of Dupuytren contracture.