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Surgery vs NA
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01/08/07 22:54
Wanker 
01/08/07 22:54
Wanker 
Surgery vs NA

The arguments raged on for years in the Biospecifics Dupuytren's Disease Patient Discussion Forum- is traditional surgery better or is NA a better path. The posts are spread all over the forum. Some were deleted by Biospecifics because they were too old. Many contributed to the debate, but two stand out. Randy expressed himself the best as a spokesman for NA while, like it or not, Sean made a good case for surgery. I am writing this to ask Randy to summarize the debate. Since he was such an active participant I think he is best suited for this task.

01/09/07 00:04
jim_h 
01/09/07 00:04
jim_h 
Re: Surgery vs NA

Randy will no doubt respond, but I'd like to offer two opinions. Although I haven't had NA yet, I've had conventional surgeries on both hands. Both were moderately successful, but recovery was long and the surgeries took their toll in terms of scar tissue and nerve damage.

First, the debate is still relevant because people are still being advised to have surgery.

Second, I feel the debate has been settled. Most contractures can be released by NA and for those cases, there's absolutely no justification left for surgery. Some contractures can't be helped by NA. BUT, surgery doesn't work very well in those cases either. I know this because I had 2 contractures in that category. Only for something like an extreme contracture of a PIP joint, with a lot of adhesion, should surgery be considered. And even then - at this point - I wouldn't do it. I'd just wait for a better solution.

01/09/07 01:00
Randy_H 

Moderator

01/09/07 01:00
Randy_H 

Moderator

Re: Surgery vs NA

I agree with jim_h

While essentially over, I think the NA Vs Surgery debate is valuable if only to acknowledge that NA is still controversial in some circles, i.e., the CHS of *most* our newbies. It's not as though we've arrived at an NA concessus in a vacuum. They would benefit from the important scrutiny NA had been placed under on the BioS Forum.

01/09/07 07:12
DianeS 
01/09/07 07:12
DianeS 
Re: Surgery vs NA

Thanks Wolfgang, Randy and others for getting this forum going. It was sad to see the other one disintegrate as many people were helped by it, myself included. I first learned of NA on that forum after two traditional surgeries and had the combination NA and minor surgery by Dr. Denkler last May. So far, the result is holding up well.

I agree the NA/ open surgery debate is essentially over - sort of like global warming. But the educational process is far from over. When I first started reading the old forum I was pretty skeptical but was gradually won over by information posts including one from someone it turns out I had known years ago. So I hope everyone will keep posting their experiences and knowledge and encouraging everyone to checkout the NA option, even if the message seems repetitive. I have been checking this forum or the previous one almost daily for nearly three years and seeing the progress in acceptance of the technique plus knowing there is a reliable source of information on new developments is an enormous relief. I am a ceramic artist and was extremely worried that I might lose the ability to do this work. I no longer worry much about that, thanks in large part to the forum.

Keep up the good work.

Diane

01/09/07 08:50
wach 

Administrator

01/09/07 08:50
wach 

Administrator

Re: Surgery vs NA

As mentioned on the "welcome refugees" thread we will archive the majority of the posts of the BioS forum and will make this archive a public board in this forum.

Wolfgang

01/09/07 21:31
Wanker 
01/09/07 21:31
Wanker 
Re: Surgery vs NA

Since I had NA from Dr. Eaton I have been looking to people's hands and asking questions. I have found 8 folks who have DD. Some play golf with me, some were at the office, and one was the postman. All but the postman have had operations from our local hand doc. (He refuses to do anything.) They all had quick, nearly pain free recoveries. When I told them about NA they thought I was nuts! They all thought it was importand to follow their docs advice. Since they all such good results from surgery they could see no reason to try NA. Although they had surgery some time ago (none was recent) no one has had any hint of DD comming back. I looked at there hands to check their claims and they were right. I have no way of knowing how representative this sub sample is but it is possible that most DD patients have surgery with no problem at all.

01/10/07 00:01
jim_h 
01/10/07 00:01
jim_h 
Re: Surgery vs NA

Yes many people have DC surgery and it usually comes out ok. I think for common palmar contractures without much adhesion, surgery works reasonably well. Of course when people say the recovery was quick and smooth, they're talking about healing one or more large deep cuts over a period of weeks, while avoiding infection.

As Dupuytren's works its way up the fingers, into the PIP joints and beyond, surgery becomes less effectinve, recovery becomes more difficult and takes longer. The swelling of the fingers lasts for many months. If you intend to regain flexibility of those joints, the physical therapy requires several sets of tedious exercises each day. Even if you do everything right, the result - especially in the little finger - is likely to be disappointing. In my case, after all that misery, I was left with a pinky frozen at about 45 degrees. While this is better than 90, I doubt I'd go through it all again if I had the choice.

So yes, surgery can work out ok in many, perhaps most, cases. But I see little justification for it unless you can't live with the contracture and an experienced NA practicioner says that NA isn't feasable. And as far as the "hassle factor", they aren't in the same galaxy. Surgery requires a physical, anesthesia, pain killers, frequent soaking and changing of dressings, immobilization, followup visits - there's just no comparison.


01/10/07 08:46
wach 

Administrator

01/10/07 08:46
wach 

Administrator

Re: Surgery vs NA

Moermans mentions an "overall complication rate" of Dupuytren surgery of 19 percent. But that also means that more than 80 percent of the operated patients are probably satisfied. If you look only at surgeries where Dupuytren is operated for the first time (excluding recurred cases) the percentage is probably even higher.

Data collected by Keith Denkler and presented at ASSH 2006 (see e.g. http://www.dupuytren-online.info/surgery...s_denkler_2.htm) additonally show that observed percentages of nerve damage etc. can vary strongly (maybe due to the set of patients or due to specific skills of the doctor or just due to statistics).

I believe that surgery is a valid and important therapy for Dupuytren. But that does not downgrade NA: NA has siginficant less side effects (when comparing to surgery you can't count "skin rupture" as an undesired side effect of NA and then the NA side effects are about 10 times less than with surgery), the recovery time is about 10x faster and the cost probably also 5 - 10 times less.

Though we are still missing statistics NA has probably higher recurrence but surgery (though not as often, again statistics are missing) can trigger extension to other areas and accelerate growth of Dupuytren (see e.e. the story of Stefan Horn that we publish on our web site http://www.dupuytren-online.info/history_stefan_horn.htm). If you are one of those 10 - 15 percent patients that happen to be hit by severe side effects of surgery, like nerve damage or sympathetic dystrophy, you probably prefer if you had gone NA. Yet surgery can help in progressed cases where NA can't, so we ought to be happy to have both options "at hand".

Wolfgang

01/10/07 19:11
Wanker 
01/10/07 19:11
Wanker 
Re: Surgery vs NA

Thank you Wolfgang or Randy for removing my double post

01/12/07 22:47
Randy_H 

Moderator

01/12/07 22:47
Randy_H 

Moderator

In answer to Wanker's original post

The "debate" over the relative merits of Open Surgery (OS) and NA went through a number of phases and changed as Eaton and others began to lend their professional credibility to what NA proponents like myself where saying. What the NA side was originally asserting was in *direct* opposition to what was widely believed by *all* Certified Hand Specialist (CHS) in North America who knew about it:

1) NA was as safe as OS
2) NA was as effecting as OS
3) NA was cheeper than OS
4) NA was faster to recover from than OS

As such, the first two of these assertions were often met with strong objections similar to that coming from the CHS. It was firmly believed by professionals (CHS) that NA was useless if not dangerous. The only credibility NA advocates had came from posters who had personally been to France and had it done. Neither side had any real credible *data* to support their positions so the discussions became fairly personal in nature rather than substantive.

That began to change when Dr. Eaton became the first CHS to treat a patient with NA. This patient posted on the BioS site as "Betsey". She had approached Eaton with info on NA and asked him to perform it on her. Eaton freely acknowledges that his entire involvement width NA is due solely to the BioS Forum. A serge of positive posts from Eaton's new NA patients began to show up on the Forum. So great the controversy that some actually accused these posts and "fake". It was just the Internet after all.

As Eaton began to add and build NA pages to his website he was repeatedly sighted as the NA "authority". Then as new research supporting NA began to surface item #1 changed to "NA is safer than OS, especially in terms of nerve damage risk." This was significant because CHS had always warned that Never Damage was a huge problem for NA. The data was beginning to show that it was the exact opposite. Naturally that particular assertion was met with great resistance until the data became more and more substantial.

However at the same time NA advocates began to acknowledged that, in general, recurrence was more likely with NA than OS. For many, this significant drawback was well worth the advantages. It also became clear that because of recurrence NA failed for some of Eaton's' patients who then moved on to OS. We are still waiting for good Five Year Recurrence data from Eaton's practice. Anything less than five years is non-publishable.

It was at this time that I and others realized that "NA Vs OS" might not be the way to look at the debate at all. Instead I began to argue that in the "ladder" of treatment from smaller to greater invasiveness, NA mighty be looked at as simply the first step with OS as the next step if and when NA failed. For each patient this would be different depending on the severity and aggression of the disease. It then became more "both/and" rather than "eithor/or".

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contractures   technique   procedure   PNF=percutanous   Surgery   Dermofasciectomy   actually   surgeries   anesthesiologist   probably   =============================================   plasticsurgerysf   Dupuytren   non-publishable   treatment   recurrence   dupuytren-online   Wolfgang   because   complications