| Advanced Dupuytrens & Needle Aponeurotomy (NA) |
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07/29/2010 09:50
philwaite 
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07/29/2010 09:50
philwaite
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Advanced Dupuytrens & Needle Aponeurotomy (NA)
A close family friend is in his late 70's and has very advanced DD.
He had open surgery on his right hand but this was never a success and DD came back very quickly (18 mths).
His right hand now has extremely limited usage due to severe finger & thumb contractions and his left hand is rapidly catching up. Pretty soon, he will have significant problems with everyday life.
Despite the bad situation, he will not consider repeat open surgery (bad memories of the operation & a long recovery period). Frankly, it sounds like he had a particularly poor or inexperienced surgeon & the post-operation aftercare and advice was minimal. I am sure that things have improved significantly since.
Considering the very advanced state of the DD & his age, is NA a realistic option to pursue?
His GP has absolutely nothing, in terms of advice, worth listening to.
Thanks
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07/29/2010 10:23
wach  Administrator
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07/29/2010 10:23
wach Administrator
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Re: Advanced Dupuytrens & Needle Aponeurotomy (NA)
Some doctors have used and are using NA also for advanced stages of Dupuytren's (see eg at the bottom of http://www.dupuytren-online.info/needle_aponeurotomy.html). I would recommend a doctor who is experienced with NA is severe stages, not a newcomer. Don't expect the finger to fully straighten again but very signifiant improvements are possibly.
Using a splint afterwards has sometimes helped to further straighten the finger (Mainel presented that at the Miami conference http://dupuytrensymposium.com/Abstracts/Meinel1.pdf).
When the finger has been severaly contracted for a longer period of time usually the skin has adapted and might tear when the finger is straightened. That's normal and can be easily fixed.
Wolfgang
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07/29/2010 12:22
philwaite
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07/29/2010 12:22
philwaite
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Re: Advanced Dupuytrens & Needle Aponeurotomy (NA)
Hi Wolfgang,
1. Do you think that his age (79 or 80 but in a very good general state of health) would be a barrier to treatment?
2. It is several years since his operation and with zero treatment (or advice) in between.
Several of his fingers show no sign of mobility at all - pretty well 'locked-down'.
Is this now maybe past the point of no return?
Many thanks in advance,
Phil
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07/29/2010 12:53
wach Administrator
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07/29/2010 12:53
wach Administrator
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Re: Advanced Dupuytrens & Needle Aponeurotomy (NA)
Phil, the age won't be an issue because this is a minimal invasive technique. Actually, it is specifically suitable for elderly people who do not want to go surgery (again). For the rest, the doctor has to decide after looking at it. No way to do that via the Internet or pictures.
Wolfgang
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07/29/2010 13:03
philwaite
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07/29/2010 13:03
philwaite
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Re: Advanced Dupuytrens & Needle Aponeurotomy (NA)
Good advice - as always - thank you for the help - much appreciated.
Will now confidently raise the topic with our friend (in terms of definitely worth giving it a try) & then set about locating an experienced, UK based, NA surgeon.
If anyone already knows of one or two, then that would be brilliant & thanks in advance.
Edited 07/29/10 16:05
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07/29/2010 14:27
wach Administrator
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07/29/2010 14:27
wach Administrator
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Re: Advanced Dupuytrens & Needle Aponeurotomy (NA)
Phil, there are several experienced ones in the UK, probably more than we are listing on http://www.dupuytren-online.info/NA_list_UK.html, but I don't know which of them would treat a stage 3 contracture with NA. Maybe it would make sense to call them upfront explaining that the contracture is already progressed to x degree, a surgery is not desired, and whether the doctor has experience in treating stage 3/4 patients with NA.
Good luck!
Wolfgang
philwaite:
Good advice - as always - thank you for the help - much appreciated.
Will now confidently raise the topic with our friend (in terms of definitely worth giving it a try) & then set about locating an experienced, UK based, NA surgeon.
If anyone already knows of one or two, then that would be brilliant & thanks in advance.
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