I met with the hand surgeon and was advised that there were three chords in my hand which would need to be injected with the drug Xiaflex in lieu of surgery. I understand there will need to be one month between each injection, while surgery would address all of problems at one time. I would appreciate any advice about which option I should undertake, injection or surgery?

(I posted this question nearly three months ago when I first discovered this forum. I had just returned from visiting one of the most highly regarded hand surgeons in the central United States. This surgeon explained I had two options; to wit surgery or Xiaflex. He did not mention NA as even a viable option. He did encourage surgery based upon my condition.

Fortunately, after returning home from my visit with this renowned hand surgeon, I browsed the internet and discovered this forum and even more fortunately engaged in a message exchange with moderator RANDY H who pushed me to find a doctor who did the NA procedure. I never heard of NA even from friends with Dupytrens. At first, I thought why would one of the nation's top hand surgeons not tell me about this option even if he could not perform it? I thought to myself that as an attorney, I sometimes encounter clients that have legal issues beyond my expertise and I refer them to others. Alas, this did not happen with me.


However, with the urging of Moderator RANDY H in this forum, I researched the specialists listed on this web site who peformed NA. I have to admit I was impressed when I discovered that there were well credentialed, board certified orthopedic surgeons and hand specialists who actually did the NA procedure. Unfortunately there were none located where I lived. The closest such physician was Dr. Peter Barre in Dayton, Ohio which was about a 2.5 hours drive from my home. Nevertheless. I contacted Dr. Barre's office and it took nearly 3 months to get an appointment. I had my NA yesterday and the results were terrific. The procedure took about 45 minutes. I had 3 chords involved. Dr. Barr gave me 10 local anesthetic shots in my hand. These were minor mini stings which were not a problem. Other than that. I felt nothing. I walked out of his office with my little finger fully extended where it had been bent at about a 45 degree angle previously. Before the surgery, I could barely shake hands (and then only fingers) because my thumb web was constricted so badly. Immediately after the NA, I could fully shake Dr. Barre's hand. My index finger did not improve as radically as the other two chords but still improved significantly over what it had been before the NA.

Needless to say, I am very happy with the results. I was facing a very expensive (out of pocket deductible) with Xiaflex and a 3 month process for administering these injections. With surgery, which is what the renowned hand specialist I first saw advocated, I was facing months of recuperation and unnecessary risks associated with the surgery. Shame on my initial doctor for not advising me of the NA option and thank you to RANDY H for pushing me to see a hand specialists who did the NA procedure.

I am sure, like most medical interventions, that one patient's solution does not fit everybody but based upon my experience, I STRONGLY encourage any one with Dupytrens to also be evaluated by a hand specialist who has significant experience doing the NA procedure. You will not regret it.

THANKS AGAIN RANDY H!!!!!

Edited 10/20/12 14:07

How much have your fingers contracted? Some people do not have much contracture and don't ever need a procedure. Everyone is different with the different procedures. I will have surgery when, or if,my other fingers contract on my other hand. I had surgery on my left hand (little finger, 90 degrees contracture) 10 1/2 years ago and it is difficult to tell that I ever had Dupuytren's. The surgery turned out perfect and still is.

Generally the advice is to have NA, or Ziaflex early on if the contracture is not too bad. I will have surgery at 35 degrees contracture.

callie:

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How much have your fingers contracted? Some people do not have much contracture and don't ever need a procedure. Everyone is different with the different procedures. I will have surgery when, or if,my other fingers contract on my other hand. I had surgery on my left hand (little finger, 90 degrees contracture) 10 1/2 years ago and it is difficult to tell that I ever had Dupuytren's. The surgery turned out perfect and still is.

Generally the advice is to have NA, or Ziaflex early on if the contracture is not too bad. I will have surgery at 35 degrees contracture.

It sounds to me like you are a candidate for NA. It is much cheaper and usually no problem with getting insurance to pay. Medicare paid and my secondary paid the rest. Cost as I recall was about $600-800 for release of cords in about 6 places. Dr. Denkler will release more than one place along a cord.

The procedure took 20 minutes, about 45 minutes total in Dr. Denkler's office. Drove myself there and back. Kept my had elevated for 72 hours, although they said 48 hours. Took bandages off after 40-72 hours. No swelling. Kept Bacitracin on the punctures that I could barely find for 2 weeks. No limitations in use except to keep hands out of still water (shower vs. tub bath, no hands in dishwater, no swimming).

I encourage people to email pictures to Dr. Denkler. He'll respond with his opinion in usually 24-48 hours. He's a super nice person. He has straightened fingers with more than 90 degrees. The sooner the better for getting this procedure. I had mine released at about 20 degrees. The more it is contracted, the greater the chance for skin splitting, but that's the case with surgery or Xiaflex also.

If you have questions, post or message me if you want.

Randy_H:

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Mike,

Please, carefully consider what is being said here about NA. I have Dups in both hands. I had Open Surgery on my left and then later had NA done on my right with Dr. Eaton. The difference between cost, recovery, pain and outcome was Night And Day. I speak with years of experience and study into this disease and current treatments. You would do well to rephrase your question to: “Injection, Surgery or NA”. No, your surgeon didn’t mention NA. That’s because he doesn’t do it. Here is a guy who does:

http://www.handcenter.org/

And more who do as well:

http://www.dupuytren-online.info/NA_list_North_America.html

You probably can find a good CHS close to you who will recognize the value of adding “NA” to your list of options. Please, kick the tires a bit more before you let someone open your hand with a scalpel or pay through the nose for an injection that has *never* been proven to be superior to the results of NA. In fact in Germany Pfizer withdrew collagenase from the German market because NA was so entrenched they could not compete with it. That is a serious fact that all those seeking treatment must consider.

Been there, done that.

Edited 10/20/12 14:00