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Dermofasciectomy
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01/13/07 18:23
Bob_Branstetter 
01/13/07 18:23
Bob_Branstetter 
Dermofasciectomy

I have been somewhat surprised that there has been little or no mention of Dermofasciectomy on this or the other Dupuytren's site. As a 65 year old lifetime professional musician, I have done much research since I was diagnosed with Dupuytren's about 5 years ago. The first hand surgeon I contacted was a member of one of the large orthopedic groups in Kansas City. He suggested that I do nothing until the fingers had more than 30 degrees of contraction. While waiting for that to happen, I heard about the then new French NA method and even considered a trip to France. Over time, the growths on my ring and little finger were getting significantly larger and starting to interfere with my playing. When my wife broke 2 of her fingers, she got an appointment to see Dr. Lynn Ketchum in Overland Park, Kansas. http://www.lynndketchum.com/surgeries.htm. While there, I learned that Dr. Ketchum had been been performing the Dermofasciectomy surgery since about 1970 and had written over 15 papers on the subject in medical journals. Dr. Ketchum is a Plastic Surgeon as well as a hand surgeon. When I did an Internet search I found several research studies which showed the recurrence rate with Dermofasciectomy to be about 8-11% as compared to 40% or more for the typical fasciectiny surgery.

I had the surgery on January 2nd. The amount of pain I have suffered has been minimal compared to other surgeries I have had in the past. The pain, which is more like an ache than real pain, has actually been more from the site on my upper arm where the skin grafts were taken than from the hand itself. I will have the stitches removed next Friday and Dr. Ketchum says that I should be able to return to work in 6 weeks or less from the date of surgery. I'll try to give updates as time passes. Here are a couple of articles that are good reading on the subject.

http://www.jbjs.org.uk/cgi/reprint/82-B/1/90.pdf

http://www.ccmbel.org/Chap15.html

01/14/07 13:47
wach 

Administrator

01/14/07 13:47
wach 

Administrator

Re: Dermofasciectomy

You are rasing a good point and maybe we should include a comment on dermofaciectomy on our web site. Please keep us updated on how you are doing.

The second link that you cite at the end of your post is a chapter from Moermans' thesis. Moermans himself is a little sceptical about dermocfaciectomy and writes in his conclusions (chapter 16):

"Dermofasciectomy allows a very good if not perfect control of recurrences but there is a price to pay in the form of many more complications."

Maybe Lynn Ketchum has a better control of complications, and in your case the skin grafting seems to have worked well which is good.

Wolfgang

01/14/07 16:28
Bob_Branstetter 
01/14/07 16:28
Bob_Branstetter 
Re: Dermofasciectomy

I have to wonder if one of major reasons for problems with the skin grafts is that the great majority of surgeons performing Dupuytren's surgery are orthropedic trained. Plastic surgeons on the other hand deal with skin grafts on a daily basis and may simply be better prepared for this particular type of surgery. Dr. Ketchum has performed over 400 Dermofasciectomies. I would think that there are most likely many other surgeons around the world who are also having good results with this particular type of surgery. As much as I respect Dr. Ketchum, I doubt that he is unique in his abilities.

One of the reasons I chose this surgery is that I had the recommendation of another musician who had had the surgery by Dr. Ketchum. I weighed the facts and decided that for me, it was worth the risk involved considering that my playing career had a much better (statistical) chance of continuing with Dermofasciectomy than with conventional fasciectomy or NA. I just brought this up because I think everyone should be aware that there is one more alternative.

01/14/07 17:03
wach 

Administrator

01/14/07 17:03
wach 

Administrator

Re: Dermofasciectomy

Bob, you might be right and definitely there is skill and experience involved. But Moermans is also a plastic surgeon. How much skin has been transplanted on your hand?

Wolfgang

01/14/07 17:59
Bob_Branstetter 
01/14/07 17:59
Bob_Branstetter 
Re: Dermofasciectomy

Although Dr. Moerman is a plastic surgeon, he compiled his information from many sources and unless I missed a reference, there is no breakdown of the other surgeon's specialties. One thing that Dr. Moerman does not dispute is the very low rate of recurrence with Dermofasciectomy. I made a point of including multiple references so that both the good and the not so good would be brought out. If there were a perfect procedure available that worked great every time for every person, there would be no need for web sites like this one. There are certainly advantages and disadvantages for each of the available methods of treating Dupuytren's.

I can't give you any specifics on the size of the (three) grafts since I have not actually seen the grafts with my own eyes yet. I will make a point to report on this once I do see them. The remaining bandages and stitches come out next Friday.

01/19/07 20:07
Bob_Branstetter 
01/19/07 20:07
Bob_Branstetter 
Re: Dermofasciectomy

Today was stitch removal day. Dr. Ketchum had warned me ahead of time that at this stage, the skin grafts would not be pretty and they certainly were not. I won't go into a description other than to say that I didn't feel like going out for lunch after this office visit.

The grafts on the two fingers are roughly 1.5cm by about 3cm. The larger one on the palm is about 3cm by 4cm.

For the next 3 weeks I have to keep a light coating of Bacitracin Zinc Ointment on the grafts with cotton gauze squares and a self adhering elastic bandage covering them. The fingers are straight and I was instructed to use the fingers as much as possible. Dr. Ketchum said it will take about 3 months for the hand and particularly the skin grafts return to before surgery appearance (minus the Dupuytren growths of course). No Regrets.

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