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hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??
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07/22/15 18:58
newman 
07/22/15 18:58
newman 

Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

Hi Lorrainehart,
You should consider NA or PNF. Dr Stewart FLEMMING at Fremantle Hospital is listed as carrying out NA on this site. I recently had the procedure on both Index fingers in Adelaide. It takes about 20 minutes or so. You will need to wear a night splint after.
My out of pocket expense was $480 for each finger. Collegenese has been approved for use in Australia ,but too expensive and NA. does the same. Dont wait too long.

Edited 07/22/15 19:01

07/22/15 21:57
spanishbuddha 

Administrator

07/22/15 21:57
spanishbuddha 

Administrator

Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

newman:
Hi Lorrainehart,
You should consider NA or PNF. Dr Stewart FLEMMING at Fremantle Hospital is listed as carrying out NA on this site. I recently had the procedure on both Index fingers in Adelaide. It takes about 20 minutes or so. You will need to wear a night splint after.
My out of pocket expense was $480 for each finger. Collegenese has been approved for use in Australia ,but too expensive and NA. does the same. Dont wait too long.
Agree with Newman, get the hands as straight and as functional as possible with NA, then if there are ongoing signs of recurrence consider RT.

07/24/15 23:16
bstenman 
07/24/15 23:16
bstenman 
Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

I had my first NA treatment of my hands done in March of 2007 followed a month later with X-ray treatment in Germany.
I had the Xiaflex injections done on one hand in March of 2011.
I had Xiaflex injections done again in July of 2013 and again in November of 2013.
The last time the Xiaflex was injected the hand surgeon, Dr. Denkler of Larkspur, California did a NA procedure while doing the manipulation required with the Xiaflex.

This last procedure produced much better and longer lasting results. Dr. Denkler is a certified hand surgeon with experience in fasciectomy, NA, and Xiaflex injections having done all of these procedures on hundreds of patients. This is very important as he could make a better assessment of what procedure or combination of procedures would produce the best results in my case.

The Xiaflex injections were done in the morning of the first day. The enzyme works for less than 12 hours. There is a resulting swelling of the hands that takes place over a period of days. The first time I had the injections done the swelling doubled the size of my hand and resulted in the skin tearing loose and a recovery time of 4 weeks.

The last time that the Xiaflex was injected I conferred with Dr. Denkler and when he told me that the enzyme's effect lasted less than 12 hours I asked to have the manipulation done of my hand the afternoon on the day following the injections which were done in the morning. As he applies a general anesthetic that numbs the entire hand prior to doing the manipulation he was able to take advantage of the situation to use NA where the enzyme had not been entirely effective in releasing the underlying tissue.

Dr. Denkler mentioned that NA in general is more effective but Xiaflex is safer where there are nerves which might be damaged by the NA procedure. By using the Xiaflex first and then the NA the following day the net result was much greater than would be possible with either procedure alone.

The last time that Dr. Denkler did the injections and the NA he applied the local anesthetic to the vein at my wrist and this immediately numbed the entire hand and was much less painful than having multiple individual injections of the local all over my hand and fingers. I highly recommend this approach.

As for surgery there is a 6% chance (at least 4x greater than with NA) of permanent nerve damage to the hand. The principle reason for this is that the surgery takes more than 90 minutes and during this time most surgeons simply apply a tourniquet and completely stop the flow of blood to the hand and to the nerves.

Recovery with surgery is also measured in months as compared to NA alone where I had 100% use of my hands the next day and with Xiaflex the full recovery the second time with the new process was one week.

There were 8 doctors approved to perform the Xiaflex injections that were closer to home but they did not have the experience with either NA or Xiaflex to decide which would provide the best results or present the least risk. A couple were sports medicine doctors and not certified to perform hand surgery of any kind.

At this point in time my experiences leads me to conclude that a combination of Xiaflex followed by NA will provide the best initial results and delay recurrence the longest.

07/25/15 00:08
Stefan_K. 
07/25/15 00:08
Stefan_K. 

Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

Interesting, thanks. I suppose performing NA on a strongly swollen hand requires special training as the "anatomy" and the position of the cords under the skin and possbily vs. the tendon may be altered. I wonder whether that increases the risk of collateral damage.

You state "As for surgery there is a 6% chance (at least 4x greater than with NA) of permanent nerve damage to the hand". What is the source of the data suggesting that up to 1 NA patient out of 100 ends up with permanent nerve damage?

07/25/15 02:43
bstenman 
07/25/15 02:43
bstenman 
Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

There have been studies by organizations of hand surgeons with studies involving many patients in Europe. NA is too new in the USA for similar studies. I researched this carefully when the first hand surgeon I met with told me that risks for NA were 6x as high as with fasciectomy but he had no references to provide me. But the information is online only difficult to find free non-subscription sources. My own research was done over a period of months prior to my getting the NA procedure done in California and the XRT performed in Essen, Germany.

With the fasciectomy risk there is the paper written by Dr. Denkler and presented at the annual convention of hand surgeons:

Surgical Complications Associated With Fasciectomy for Dupuytren's Disease: A 20-Year Review of the English Literature by Keith Denkler, MD

http://www.eplasty.com/index.php?option=...&Itemid=116

NA complications includes procedures done for "trigger finger" and by all doctors over a period of decades. This procedure was first developed in France and surgeons including Dr. Denkler had to go to France to learn the procedure.

All surgical procedures involve some level of risk. Even cortical steroid injections when overdone (usually with athletes) have led to burst tendons and permanent disability.

Don't expect a surgeon to talk about complications or recovery as they are very seldom involved in post surgery for patients. The surgeon who wanted to perform the fasciectomy told me to go ask a physical therapist if I wanted to know about post surgery physical therapy and the recovery interval to expect.

07/25/15 02:48
bstenman 
07/25/15 02:48
bstenman 
Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

Good to understand that whatever procedure is done it is not likely to be permanent but will need to be repeated again and again. I have had 3 NA procedures and 3 Xiaflex injections over a period of 6 years.

The risk of a complication from a procedure is compounded the more times it is performed. Numerous studies with regard to surgical procedures in general by the feds and other organizations have also shown that the fewer procedures a doctor has performed the more likely they are to make a mistake that results in complications including disability or death. The hospitals where the most operations of any kind are performed have far lower rates of complications than their peers.

07/25/15 09:48
spanishbuddha 

Administrator

07/25/15 09:48
spanishbuddha 

Administrator

Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

The thing I find strange is that you have said is NA was done when the hand was totally numb. This is not the usual reported technique or practice. The surgeon doing NA is working blind using feel and relying on the patient to report if it gets too close to a nerve. So usually only partial or local numbing at point of entry is done. If the needle approaches a nerve the patient feels slight electric shocks and can provide this feedback to the surgeon. This is essential to ensure NA does not result in nerve damage especially for those cases where cords are close or intertwined with nerves.

05/25/21 23:39
AvAlanche 
05/25/21 23:39
AvAlanche 
Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

dannyboy:
Hello David,

Danny here in Dublin,...i have the same as you but in both of my small small fingers on both hands that are now at 90 degrees bend or slightly more,..

I decided in Jan this year to have something done about this (kept putting it off for years), but in Ireland it is hugely expensive and and the relatively few doctors here that knoew anything about Dupuytrens were all for open surgery which i was very wary of,...anyway i did some research and thankfully discovered this site,....and Seph (amongst others) on here who is living in Aus has been very helpful to me with advice,...

So on the 1st of March i travel to Paris to see Dr Marie Chopin for the N/A needle jobbies on both hands which hopefully will go someway is straightening my pinkies, we shall see,... but it is much better than surgery,..and the cost is Euros 200 per hand,...

Contact details are
Dr Manet-Chopin works in a private hospital but on some days she does NA in consulting rooms next to metro Place d'Italie. The consulting rooms have an english speaking receptionist from 2pm t0 6pm (Ph + 33 1 43 37 90 47)

I will let you know the results in two weeks time and good luck with what you decide to do,..

How did you get on with N/A in Paris @dannyboy ? I hope it worked out well for you.

I am 36 and have 2 Dupuytrens lumps on my palm. I went to a Consultant in Cork who said there was an injection but, it's been taken off the market and is now used to treat cellulite instead, so it is too expensive. She told me, I will have to wait until it gets bad enough for surgery and could only offer a steroid injection for the pain....

I am curious about the treatment in Paris...

Edited 05/25/21 23:41

05/26/21 00:46
bstenman 
05/26/21 00:46
bstenman 
Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

Xiaflex is still available and has not been taken off the market. With a standard NA procedure the doctor will make multiple injections of lidocaine before starting the NA procedure and doing so with the patient's hand completely numb. A competent hand surgeon is not going to do this procedure without a local anesthetic.

Instead of 6 or more injections into the hand, the doctor made a singel injection at my wrist and this was less painful. Of course the hand surgeon I used, Dr. Denkler in California has more direct experience with NA and with Xiaflex than any other doctor in the United States.

NA is a surgical procedure where the doctor inserts a "scapel" and pulls the surface tissue away from the lower layer. The Xiaflex enzyme dissolves tissure. With Dr. Denkler I had a surgeon with a great deal of experience with traditional fasciectomies and with NA (he trained in France) and with Xiaflex so he had options. The older surgeons who only have performed fasciectomiers are cluelss about NA or Xiaflex and not to be trusted for advice.

With a fasciectomy a tourniquet is applied to the arm and the muscles and nerves are without oxygen for 90 minutes and this often results in serious post surgery complications. No unusual for it to take a month or even a year to regain strength in the hand after the operation as compared to NA where 24 hours later I had full use of my hand.

In February of 2011 Dr Denkler did the combination NA and Xiaflex injections on my hand and now 10 years later my hand is still OK and I can place it flat on a table with no effort. The cost for the NA along with the Xiaflex treatment was the same as if I had only the Xiaflex injections done.

05/26/21 08:01
spanishbuddha 

Administrator

05/26/21 08:01
spanishbuddha 

Administrator

Re: hmmm.. Xiapex or NA or maybe surgery or then again maybe NA??

bstenman:
Xiaflex is still available and has not been taken off the market.
Collagenase is no longer generally available in many countries, this includes Europe and some others. This was a cost and marketing decision. It remains in use in the USA as Xiaflex. I have heard some UK doctors continue to use it privately, sourced via private means. More here https://www.dupuytren-online.info/dupuyt...se_clinics.html

This thread has a useful report by someone who was treated in Paris https://www.dupuytren-online.info/Forum_...34176780.html#4

Edited 05/26/21 08:05

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