| Amputation of little fingers on both hands |
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10/14/2011 13:37
Mofa 
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10/14/2011 13:37
Mofa
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Amputation of little fingers on both hands
I have a colleague with severe Dupuytrens to both hands. At a consultation yesterday, he was advised that his condition was not suited to injections. He was advised that he could have both hands operated on, but as the knuckles in his fingers were damaged, he would require skin grafts etc., and there was no guarantee of success. An option suggested was amputation of the little fingers to both hands. Has anyone experience of amputation etc. ? Would really appreciate any suggestions.
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10/14/2011 13:55
spanishbuddha  Administrator
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10/14/2011 13:55
spanishbuddha Administrator
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Re: Amputation of little fingers on both hands
Mofa:
I have a colleague with severe Dupuytrens to both hands. At a consultation yesterday, he was advised that his condition was not suited to injections. He was advised that he could have both hands operated on, but as the knuckles in his fingers were damaged, he would require skin grafts etc., and there was no guarantee of success. An option suggested was amputation of the little fingers to both hands. Has anyone experience of amputation etc. ? Would really appreciate any suggestions.
A person I know with severe Dupuytren's Contracture, and who works with his hands, had a pinkie amputation recently. Compared to the hand disability he was experiencing before the operation he is pleased with the outcome.
However - although he has no other problems in the hand, it still took several months for the pain and swelling to go. So perhaps your colleague should get a second opinion, especially if you have the disease present elsewhere in the hand and not just the pinkie.
I also have a pinkie amputation, but not because of Dupuytren's, and mine was done at a very early age, so I have adapted and live with it very well, including playing piano. My pinkie was amputated along with the knuckle joint so my hand looks 'sculpted' and there is no obvious missing finger, unless you count them. The person I mention above had his pinkie amputated but not the knuckle, so there is a clear stump that make it quite obvious a finger is missing from the hand. The appearance may be an aesthetic consideration but it's possible, and I don't know, that the knuckle stump catches on things (pockets, edges, etc).
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10/19/2011 07:41
Mofa
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10/19/2011 07:41
Mofa
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Re: Amputation of little fingers on both hands
Thank you for your response - very helpful and useful. Obviously, will need to do more research!
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12/04/2011 18:59
bstenman 
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12/04/2011 18:59
bstenman
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Re: Amputation of little fingers on both hands
In my own experience with my old GP and with four hand surgeons is that if the doctor like the great majority of doctors in the USA has experience with performing amputations and fasciectomies then they offer the pros and cons of these two options as compared to doing nothing. I would go to a hand surgeon, regardless of how far I had to travel, who has done NA and Xiaflex procedures and get them to evaluate the condition of the hands. Based on the information this doctor provided I would decide what to do which might include getting a consultation with another NA/Xiaflex experienced doctor.
The amputation would fix the problem but it is a very heavy handed (no pun intended) approach which is not reversible. It seems to be a typical approach of the majority of surgeons who like quick "fixes" and do not have to deal with the outcome of the surgery, only their insurance company does in a worst case scenario. Surgeons make literally 10x as much for a surgical procedure than for doing a NA or Xiaflex treatment on an outpatient basis. Have to think that this biases their judgment more than a little.
The surgeon who advised me to get a fasciectomy, which of course he could perform, was completely clueless about the probable length of the physical therapy and lied about the risk factors as well as the high probability that I might never regain full hand strength after the surgery and the the PT would take several months.
I would never take any single doctor's recommendation regarding surgery. There is seldom a need to do this and I believe that good information is critical to making good decisions. The more doctors I meet with the more information I can collect.
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12/04/2011 21:23
callie
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12/04/2011 21:23
callie
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Re: Amputation of little fingers on both hands
Is that true? "Surgeons make literally 10x as much for a surgical procedure than for doing a NA or Xiaflex treatment on an outpatient basis."
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12/05/2011 05:30
wach Administrator
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12/05/2011 05:30
wach Administrator
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Re: Amputation of little fingers on both hands
Of course it depends on the country and I can't speak for the USA. In Germany surgeons make the most with surgery, followed by NA (where they earn 1/3 - 1/10 of surgery, depending on insurance). The last is Xiaflex where they, at least for the time being, earn close to nothing, certainly less than the time they invest. They only do Xiapex because it's new and patients ask for it. Pfizer (marketing collagenase in Europe) still seems to have difficulties resolving this issue of a very expensive medication with underpaid treatment.
Wolfgang
callie:
Is that true? "Surgeons make literally 10x as much for a surgical procedure than for doing a NA or Xiaflex treatment on an outpatient basis."
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