Yesterday I saw 2 well respected consultant hand surgeons and had long discussions with both about treatment for DC in my right hand. They both agree that I have left it rather late and that the only option for me is a 2+ hour open hand operation (usually operation takes about 40 minutes) together with a skin graft and intensive physiotherapy which may take a considerable time before my hand is anywhere near normal.

I LIST BELOW A SUMMARY OF WHAT WAS SAID TO ME:-

When questioned about colagenase they seemed to agree that it is not proven, has been about for years, will not be available for years, and will have very limited use in early stages of DC.

Their comments on NA were that it was a temporary fix, again limited to use in the early stages of DC with dangers of nerves being destroyed as the needle is entered into the hand blindly. This could cause permanent damage to the function of the hand. It is not very successful on PIP joints.

RT is likely to cause problems later on as it would probably damage blood vessels etc.

The best option is open hand surgery as early as possible, with skin grafts, (Early operation means less intrusion and a much quicker recovery rate) followed by intensive physiotherapy. The skin graft reduces the risk of re-occurrence. The graft is usually taken from the inside arm, just below the elbow.

I was also told that it has been known from 1826ish that splinting the hand will keep the contraction at bay but will not stop progression of DC.
I would suggest that on that basis it is sensible to obtain an appropriate splint to, at least, hold back the contraction until such a time as a decision is made on what course of treatment any individual is going to take or until operation date.

My conclusion is:-DON'T PROCRASTINATE, GRAB THE NETTLE AND GET IT DONE AS SOON AS POSSIBLE! (Less complications)

Edited 04/17/09 11:47

You got a surgeons' opinion. You might talk to NA and radiotherapy doctors as well to get broader picture.

My 5 cents, not meaning to influence your decision but to correct some of the statements you wre given:

"collagenase they seemed to agree that it is not proven, has been about for years, will not be available for years, and will have very limited use in early stages of DC." --- Strange. Its efficiency is clearly documented and it will be probably be available within the next 12 months. I guess they are not quite up to date on that. More info on http://www.dupuytren-online.info/dupuytren_collagenase.html.

"NA ... a temporary fix, again limited to use in the early stages of DC with dangers of nerves being destroyed as the needle is entered into the hand blindly. This could cause permanent damage to the function of the hand." --- NA can be applied even to stage IV patients (see http://www.dupuytren-online.info/needle_aponeurotomy.html ). The danger of nerve damage is significant less than with surgery (see http://www.dupuytren-online.info/NA_side_effects.html). Surgery can also cause permanent damage to hand, stating that for just NA is quite misleading.

"RT is likely to cause problems later on as it would probably damage blood vessels etc" --- Where do they have that from and what is "etc"? I myself had radiotherapy about 25 years ago and have no problems at all. Agreed, that's not a proof, but their statement is even less proven.

"Early operation means less intrusion and a much quicker recovery rate." --- Maybe, maybe not. The recovery time depends on a lot of things. Early operation might trigger extension of the disease in other areas with rapidly growing nodules (only for the minority of patients but still not a rare effect). I would rather postpone surgery as long as possibble.

"The skin graft reduces the risk of re-occurrence." --- True. But your transplanted skin might look different to the other skin and it might feel and react differently. Newman can tell you more about that. He had several grafts. Just curious: Are you located in the UK? For whatever reason doctors in the UK more easily recommend skin grafting than elsewhere. Maybe they have more experience with it.

Wolfgang

Edited 04/17/09 15:48

Hi handhurt1 -Australia Calling,
I hope you have not left the contraction get to great, as sometimes depending ,which joint and finger is affected there may be no guarantee of obtaining a complete release.You make mention of having a skin graft.I was only advised to have skin grafts ,after I had been operated on a number of times and my surgeon advised ,that I was one of those patients, who had an aggressive form of dupuytrens.( formation of knuckle pads etc. ) I did have a graft done over a previous surgery .I have a graft on the left hand in the web between the thumb and forefinger, including the joint adjacent to the palm. (50X20 mm.) My left ring and little have a large graft(70X40mm)extending into the palm. My right hand takes in the little finger extends into the palm area up to the middle of the hand (50 X50 mm) My right thumb over the joint has a smaller area (25X5 mm.)
The downer skin came from the groin area. My grafts are of a total different colour, brownish , to the rest of my skin tone. (nobody has ever commented ) You don't mention your age.I hope you are not diabetic, as there could be additional problems preventing the graft from taking. It is difficult to graft to the inside of the hand , The graft must take quickly,within days ,ie blood supply, otherwise you are in big trouble. Do you know, that there is only one layer of skin on a graft, so you have to be careful with your hands .I always have to wear gloves ,preferably the cotton type with rubber facing for grip. I tell you it is a big decision to have a graft. The graft of course reduces the scar tissue and allows full use of the joint .However the gaft does stop the progression of cords etc . Get a second opinion .Ask how many grafts the surgeon has done. Mine had done many on burn victims. He was a hand surgeon as well as a plastic surgeon.Hope this scares you enough to maybe get 4 opions before you decide.
Regards.

Edited 04/19/09 12:49