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I chose to write here because I quite frankly got tired of reading a constant barage of "NA is the best choice" and virtually no positive discussion of the other options. Recurrence rates need to be considered. When you have a disease that has no cure, some of us are looking for the most "permanent" procedure available even if it is not the least invasive.

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Bob, your comments had effect: I don't know whether you already noticed it but we now included on our web site an overview on surgical techniques and included dermofasciectomy.

We also comment on the issue of recurrence. When you get into the details who measures what then the reported numbers on recurrence become, at least, questionable. Those on partial fasciectomy seem to vary between 2 and 65 percent ...

I hope your frustration about missing options other than NA does not refer to our web site! We, and that includes Randy, consider surgery an important option. But surgery and surgery are not the same and there are various other options, including NA. Already in 1959 Luck criticized "In the past, little attempt has been made to classify the stage of the disease and them employ therapeutic methods based upon the predominant stage of the process". We try to learn from that and do better.

Wolfgang

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Bob, your comments had effect: I don't know whether you already noticed it but we now included on our web site an overview on surgical techniques and included dermofasciectomy.

We also comment on the issue of recurrence. When you get into the details who measures what then the reported numbers on recurrence become, at least, questionable. Those on partial fasciectomy seem to vary between 2 and 65 percent ...Wolfgang

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I'm sorry to admit that I had not looked at the website recently and did not know about the new inclusion of dermofasciectomy.

When I have more time, I'll go back and document some of the other sites where studies of recurrence have been made. Unfortunately, I did not take the time to save the links and references to most after I read them prior to my surgery. The most common figures I've seen are in the 40-50% range for fasciectomy and some of these studies include data going back to the beginning of dermofasciectomy in the 1950s. I hope someday to be able to present the as yet unpublished paper by Dr. Lynn Ketchum on his 35 years and over 400 cases of Dermofasciectomy procedures. While we can quibble over the exact percentages and exactly how they they were derived, even the critics of Dermofasciectomy concede that the recurrence rate for Dermofasciectomy is less than that of any other procedure currently available. Thank you Randy and thank you Wolfgang for giving me the opportunity to present this to the forum for consideration.

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Bob:

We all appreciate your thoughtful post.

Mark

My livelihood as a photographer require the full use of my hands. When deciding between the treatments available in the USA the choices came down to fasciectomy or NA. Of all the physicians covered by Blue Cross, only one actively performs fasciectomies.

For me the deciding factor was the risk of complications, which were naturally much higher for the more invasive fasciectomy procedure. This including the risk of a loss of hand strength which for me would be worse than the contracture. Add in the 3-6 month recovery period for each hand, and NA became for me the logical choice.

I will be having the NA procedure done next week. I plan to follow up the NA procedure with radiation treatment in Germany. I might be able to find an oncologist who could be convinced to provide the treatment in the USA, but I like to go with doctors who have as much experience as possible with whatever course of treatment I choose.

USA federal government studies show a strong correlation between frequency of performing an operation and the incidence of complications. Few operations per year results in a disproportionate incidence of complications from botched surgeries.

At the present I view NA as the best short term treatment to treat the contractures which are symptomatic of Dupuytren's, and RT as the best treatment to minimize the likelihood of recurrence and future disease progression with minimal side effects.

Enzyme injections may also be a treatment option in 5 years, and a chemical alternative to NA. Gene therapy may also become an option at some point in time. We may also benefit in the future from research and treatments developed for other fibrotic conditions.

I am looking for the best approach which may be a combination of approaches, including NA, RT, and NAC as a dietary supplement. I am much more concerned about probable side effects, complications, recovery time, and the possibility of permanent disability from an operation than about recurrence. I am concerned that one form of treatment now, that may preclude my future treatment options.

There are personal factors that need to go into any decision matrix, including the person's age (25 versus 55), profession and need for full use of their hands, stage of progression of the disease, tendency toward scaring, and the presence of any other medical conditions.

Ordinarily, as with a cancer patient, one could expect to receive an overview of the pros and cons of each treatment approach (and the most successful today are often hetorgeneous approaches), and the statistical likelihood of a positive outcome and of complications from the various options. Unfortunately it does not seem possible to get a similar perspective based on the information provided by the medical community with regard to Duputren's.