As a completely new user of the forum and site I may be missing information that is available but which I cannot find. I know I have DC in my right hand which i can flatten by lkeaning my body weight on it (hurts though) and it is just beginning in my left hand. GP says I must wait until I am virtually disabled and the have surgery. So after using google etc etc to research I have noted that many UK patients state they "went to France" or "went to Paris". I have also now downloaded the list of clinics in the UK performing NA(PNF). Would it be feasible to ask anyone who has had either NA or xiapex treatments in UK ; How they accessed it and if it was private where they went and what it cost ; Also in same vein someone who had treatment in France exactly the same questions ; PLEASE ; I knwo I am late to the site but I keep reading that Mr or Mrs x had very succesful treatment by NA but nobody says ; It was Dr xxxx in Paris and it cost £xxxx

Please help ;

You said, "GP says I must wait until I am virtually disabled and the have surgery".

Go to a different GP. If you accurately stated what s/he said, that is very poor advice. S/he obviously has little knowledge about Dupuytren's and it would make one wonder about his/her knowledge about other medical conditions.

Doctors Badois, Manet, Lermusiaux and LeLouche on this list http://f.badois-dupuytren.assoc.pagespro...tml/gblist.html have been recommended in the past on this forum. I think Badois may have retired?

The LARIBOISIERE hospital, is conveniently located at the other end of Eurostar and will be where I will probably go if needed. http://www.dupuytren-online.info/NA_training_literature.html

However, Mr Chris Bainbridge has some responsibility for this UK training video https://www.youtube.com/watch?v=ynSIchgNgdI so he may be able to advise within the UK. (He posted recently on this forum with a survey).

Chris; I have had NA procedures from dr Badois in the past and last Friday Dr Manet. She is very good. Knows what she is doing. Injections hurt a bit more than with dr Badois but then my hand was in a worse state.

Important issue though for anyone in the UK - The cost is 250 euros. Less than the cost of a meal at a good restaurant in the UK.

Eurostar or ezijet to paris. Treatment takes 20-30 minutes. In short you could fly to Paris in the morning, have the NA procedure in the morning, have lunch in Paris and be back in the UK by the end of the day at a total cost less than 500 euros.

And you get to see someone who has done thousands of procedures rather than someone who is starting out.

I live in Australia and my health insurer won't pay for procedures overseas. They are happy to pay $10k for surgery but won't pay $250k for NA yet it still makes economic sense for me to have a week in Paris every 18months or so and have NA there. For you guys in the UK it seems to me like an easy call.

I would like to reassure the users of this forum that there is nobody doing NA in the UK who is a beginner. They are all fully trained hand surgeons, so they have done several hundred open dupuytrens operations giving them an unmatched insight into the anatomy of the hand, the pathology of Dupuytrens disease and the normal functioning of the hand. Believe me when you have had to put back together a few full house palm lacerations with tendons, vessels and nerves damaged you know the anatomy in ways no other specialty can.

Surgeons are by nature conservative, they generally do not jump on every "new thing" as so often it turns bad. We have seen that recently with PIP implants and some hip replacements. So if your surgeon doesn't do NA, he/she is simply doing the sensible thing of giving you a treatment that has withstood the test of time for the last 100 years.

Don't forget that Xiapex is an extremely dangerous drug. The collagenase is the same enzyme that let's flesh eating bugs be flesh eating! You can now see why your surgeon might be reticent about injecting you!

Having said that there are a few surgeons in the UK who are doing NA and Xiapex. I know of at least three centres who are offering these on the NHS. In Derby we are fully commissioned to offer both. They are not straight alternatives. NA is probably best for narrower primary cords and slightly older people due to the higher recurrence rate. Xiapex is great for patients with thick cords, younger age and rapid recurrence after NA. If you are needing NA after 12-18 months to the same finger you should really think about Xiapex. There are even some people who get rapid recurrence after Xiapex. The answer for them is a dermofasciectomy early when it is a good operation or possibly radiotherapy.

We routinely see patients from all over England and my hospital management simply send a bill to your PCT.