Hi prosperina,

"My consultant dismissed RT out of hand - said the risk were too great"
That's somewhat contradicting the NICE guidance http://www.nice.org.uk/guidance/IPG368. This was issued in Nov 2010 and your consultant may not be aware of it yet.

"I'm curious as to why the strong reaction from you all against surgery? Is it because it's ineffective?"
No, surgery is a very effective treatment for Dupuytren's and sometimes the last resort. But even hand surgeons often suggest to postpone surgery as long a possible for three reasons:
a) the disease will come back and surgery can be repated typically once, seldom twice on the same finger.
b) Dupuytren's surgery is generally difficult because the hand has nerves, tendons, blood vessels, muscles all very close to each other and surgery might damage some of those causing side effects. It also requires a longer recovery time, typically months.
c) Dupuytren's can be triggered by trauma and surgery is a major trauma. Therefore surgery might cause new Dupuytren's nodules growing elsewhere and sometimes patients might even get into cycles of surgery, ending up with 5, 10 or even 20 surgeries.

You might have a look at http://www.dupuytren-online.info/dupuytr...ideeffects.html. Other therapeutical options also have side effects and they are described on this web site, too. Surgery still is an important means to release contracture and the most frequently used means.

Wolfgang

prosperina:

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My consultant dismissed RT out of hand - said the risk were too great.... I'm in the UK and having treatment on the nhs which I think has a lot to do with it... He did mention there was an injection that is effective but not available on nhs....

I'm curious as to why the strong reaction from you all against surgery? Is it because it's ineffective?

Calllie,

surgery is not a bad option but an option that you want to postpone as long as possible. And a) - c) are the reasons for that. Wouldn't you agree with this?

Wolfgang

callie:

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Wach,

Your a), b) and c) sound like a "strong reaction from you all against surgery". You start off by saying "surgery is a very effective treatment for Dupuytren's" and then give the disclaimer that accompanies almost every surgery in some form or another. It is no wonder that the casual observer gets the idea that surgery is such a bad option.

Edited 11/13/11 18:19

Good point, callie! Here is what I would consider as the benefits of surgery. Please add to it if I am missing out on something.

1) if performed well, surgery probably has the longest recurrence period of all treatments. While with NA or collagenase injection the disease can come back after a couple of years or even less than a year, a well performed surgery may hold 5-10 years and in favourable cases and with some luck even longer. I myself had surgery 10 years ago and that finger is still straight and well.

2) surgery is feasible in all stages of contracture, see the table in the paragraph "stages and therapies" on http://www.dupuytren-online.info/dupuytr..._therapies.html

3) surgery can handle cases that other treatments can't. Therefore it might turn out to be the last resort and that's definitely one of the benefits of surgery. We do need excellent hand surgeons!

4) surgery is readily available and there is more experience available with hand surgery than with any other treatment option.

With this in mind I am still maintaining my point a) - c) of my previous post. Xiaflex is aiming to provide an option that is cheaper, with less risk and much faster recovery than surgery. Nothing wrong with that, I guess. NA pretty has the same goals. Radiotherapy tries to put the disease to rest. Again, nothing wrong with that.

Wolfgang

Dr. Denkler, a hand specialist, started out doing only surgery for Dupuytren's contracture and did many of them. When he read about needle aponeurotomy (NA), he said he knew he could do NA because he knows the anatomy of the hand. He studied with Dr. Eaton and studied with the doctor in France who started doing modern day NA. He has done well over 100 Xiaflex treatments. He still does surgery. He does significantly more NA treatments, Xiaflex is next most, and the fewest is surgery. I want the least invasive treatment and surgery is far more invasive with months of recovery time. I believe there is much greater risk for permanent complications such as scar tissue that is irreversible and other risks of damage.

Dr. Denkler gave all options to me even though I knew I wanted NA. I've had NA twice with Dr. Denkler but will consider Xiaflex as well as NA next time, but not surgery. Yes, I expect to need release of cords in my hand again in 2-3 years. NA, a procedure that takes a 20 minute office procedure, recovery of keeping my hand elevated for 48-72 hours, keeping Bacitracin on the puncture spots, and keeping my hands out of dish water, pools, showers instead of baths for 2 weeks does not interrupt my life or activities.

People must make their own decision about what they think is the best treatment for themselves. I just think it is critical to know what all options are and get all information about the treatment options. When there are proven early treatment options like RT, NA, and Xiaflex but the only option given is surgery, the doctors simply doesn't know what they are talking about. NAn orthopedist, my GP, and my dermatologist all told me to wait until my fingers were contracted almost down to my palm then get surgery. I made sure that they know about the NA & RT and they are very appreciative to know that there are other less invasive and early treatment options to offer their patients who are unfortunate enough to belong to "our Dupuytren's club."

My advice: No matter what you decide, consider all options.

Callie,

I'm glad your surgery was a great experience for you and I know it has worked out well for others, too. It hasn't worked out that way for everybody.

We're back to everybody has to make their own decision. They should consider all options and then do the treatment that is best for them. As with me, it seems that most people never get any option given to them except surgery. That's a problem. The 3 doctors didn't give specific degrees of contracture, but to me 30-50 degrees is more than I was willing to wait for. I'm the kind of person who is into prevention and the early treatments kinda fall in that category.

I'm glad you post about how surgery can be beneficial as an option. People need to have information available about all treatment options,