I had XRT and NA done on my hand in 2007, Xiaflex done in 2011, Xiaflex in July 2013, and 10 days ago I had both Xiaflex and NA performed on my hand. It has become increasinly apparent that the success depends primarily on the skill and expereince of the physician.

My doctor, Dr. Keith Denkler has performed many hundred of NA procedures, performed fasciectomies, and used Xiaflex on numerous patients. He has the experience to decide when dealing with a patient's hands which procedure will be best. As with my hands there were areas where NA was safe as there were no nerve paths in the area, and other locations where Xiaflex was the best tool.

With Dr. Denkler the whole hand is numbed with lidocaine so he can take his time with the injections which he did on the first day. On the second day he again numbed by entire hand so he could do the necessary maniupulation and release work and with the hand numbed he could also do NA work in spots. His NA approach is interesting in that he will use a bent needle to slide under the skin and release it from the Dupuytren's and get a greater amount of release as a result.

The Xiaflex enzyme works over a 12 hour period so I had the injections in the afternoon of the first day and the release work and NA performed in the morning the following day. Despite the short interval I had no splitting of the skin on my hand and this approach seemed to enhance the healing process for my hand. With Xiaflex alone the swelling lasted for several weeks but with this Xiaflex and NA the next day the swelling was mostly gone by day 4. I experience none of the pain from the swelling this time which was a problem with the first Xiaflex treatment in July where the release work was delayed for 10 days.

It is clear to me that this is an evolving process and the doctors with the most experience with all the procedures and with an open mind (equally rare) can provide the best results.

A video with commentary by Dr. Denkler during the procedures is posted on youtube.com.

http://www.youtube.com/watch?v=yZ5s8Cynsyg