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Surgery vs NA
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01/12/07 22:48
Randy_H 

Moderator

01/12/07 22:48
Randy_H 

Moderator

Part II Answer to Wanker

The acceptance of Eaton's training secession at the 2006 meeting of the American Society of Surgery of the Hand pertly much ended the debate over NA's legitimacy as a first line of defense treatment. The ASSH had officially recognized it by letting it be taught at their convention. So, as it turned out, it was not the force of logic or eloquence of the NA side that eventually proved compelling. Rather it was the legitimizing effect that American CHS had actually been *recruited* into the NA movent by patient advocates on the BioS Forum. That was the amazing effect of that one little BioS Forum.

That's my take on it. I'm sure others might see it differently

RBH

01/13/07 03:45
Mark_D 
01/13/07 03:45
Mark_D 
Re: Surgery vs NA

Quote:



The acceptance of Eaton's training secession at the 2006 meeting of the American Society of Surgery of the Hand pertly much ended the debate over NA's legitimacy as a first line of defense treatment. The ASSH had officially recognized it by letting it be taught at their convention. So, as it turned out, it was not the force of logic or eloquence of the NA side that eventually proved compelling. Rather it was the legitimizing effect that American CHS had actually been *recruited* into the NA movent by patient advocates on the BioS Forum. That was the amazing effect of that one little BioS Forum.

That's my take on it. I'm sure others might see it differently

RBH



Randy:

Thanks for the great summary.

Mark

01/28/07 23:19
TrevB 
01/28/07 23:19
TrevB 

Re: Surgery vs NA

Why hasn't anyone, or have they, deleloped a minimal surgery technique if surgery is required. Those large zigzag operations always look so drastic and damaging (especially when, like me, you've only the use of one hand in the first place!). The more I read the more I dread the day that I may have to consider my options, including surgery.

01/29/07 00:08
Randy_H 

Moderator

01/29/07 00:08
Randy_H 

Moderator

Re: Surgery vs NA

Trevb,

"Microsurgery" has to do with the need to use a microscope to determine what tissue is infected with Dups and must be removed. The idea is that you don't want to leave any behind and increase the change of recurrence. That's why CHS are so suspicious of NA. The diseased tissue is left there. But that's the same with Collegenase so I've never understood the rational behind the anti-NA recurrence argument.

01/29/07 10:11
TrevB 
01/29/07 10:11
TrevB 

Re: Surgery vs NA

Quote:



Trevb,

"Microsurgery" has to do with the need to use a microscope to determine what tissue is infected with Dups and must be removed. The idea is that you don't want to leave any behind and increase the change of recurrence. That's why CHS are so suspicious of NA. The diseased tissue is left there. But that's the same with Collegenase so I've never understood the rational behind the anti-NA recurrence argument.



Why doesn't anyone use smaller straight cuts rather than those large ugly zig zag ones?

=============================================
I went to my doctor and asked for something for persistent wind. He gave me a kite!!!

01/29/07 11:52
Wolfgang

not registered

01/29/07 11:52
Wolfgang

not registered

the little surgery

Actually some do, it depends on the technique. Originally, for example at Dupuytren's time, it was much too dangerous to do large area cuts or even skin transplants. So they worked with smaller cuts. Since then sterile environments und surgical techniques improved and surgeons attempted to reduce recurrence by cutting out all of the diseases tissue and sometimes even more than that. For example Dermofasciectomy is a technique that promises probably the lowest recurrence rate but is tricky because it uses skin transplants which might or mght not work (and if they don't you are in trouble). Because of the risks and damages of "big" surgeries it has again been proposed to do "little" surgery for Dupuytren. An example is partial fasciectomy, a technique that Moermans proposed and is doing in Belgium (his thesis is on the Internet, you can find a link on our surgery page). That's only an example, there are other "little" surgery techniques, e. g. opening only the area between aponeurosis and MCP or PIP and keeping the aponeurosis intact (while other surgeons remove the whole aponeurosis in an attempt to eliminate recurrence). Surgery and surgery is not the same but it is really difficult for a patient to decide which surgical technique is actually the best for him/her.

With regard to zig-zag vs. straight: straight cuts are typically used on fingers but if you make straight cuts in the palm then the resulting scar might either contract your palm or block making a fist.

Wolfgang

Quote:



Why doesn't anyone use smaller straight cuts rather than those large ugly zig zag ones?


01/29/07 17:29
jim_h 
01/29/07 17:29
jim_h 
Re: Surgery vs NA

I've had fairly extensive surguries on both hands. The incisions were straight and coincided with natural creases in the palm and PIP joints. This technique is supposed to reduce scarring and in my case it worked very well. These were 'clearing' surguries as wolfgang describes in in fact, Dupuytren's hasn't returned in the cleared areas after several years - although it's progressed in other areas.

So on that basis, one might think surgery is the final solution. However I feel the recovery time, effort, inconvenience and collateral damage of conventional surgery is signficantly downplayed by hand surgeons - perhaps without their even realizing it. After having gone through this twice, I realize I'd rather have had NA regularly, for the rest of my life if necessary.

But - NA is expensive in this country. Besides air fare and lodging, NA practicioners are charging hundreds of dollars per finger. And insurance is less likely to cover NA. I couldn't afford to fly to Florida to see Dr. Eaton every other year and have it all redone.

So, it remains a tough decision.

01/29/07 18:15
SteveAbrams

not registered

01/29/07 18:15
SteveAbrams

not registered

Re: Surgery vs NA

Others have made the same argument about cost that Jim H does. I had NA by Eaton 2 years ago - if I remember right, the cost was around $700. I never priced surgery but it had to have been several times this figure. The real financial issues with NA are first, availability of physicians - one must pay for travel and lodging because at this time there are not enough physicians performing NA, and second, the unwillingness of some insurance companies and HMO's to pay for NA. Mine did, after I filed a protest. I would imagine that it would take 3 or 4 NA's to equal the cost of 1 surgery, so it is in the interest of all sufferers to educate their health care providers.

Steve

01/29/07 19:04
Bob_Branstetter 
01/29/07 19:04
Bob_Branstetter 
Re: Surgery vs NA

Earlier in this discussion, Wolfgang wrote: "Dermofasciectomy is a technique that promises probably the lowest recurrence rate but is tricky because it uses skin transplants which might or might not work (and if they don't you are in trouble)."

Since I have actually had this particular surgery, I would like to comment. In my post on Dermofasciectomy, I included a link to Moerman's paper (Chapter 15). I believe that Moerman tended to stress a worst case scenario with regard to skin grafts with vague statements. From my reading of his paper, it appears that he has never actually performed this surgery himself (although he is a plastic surgeon). Most of chapter 15 is simply a critique of Hueston's work and research. I discussed some of the problems which the Moerman paper mentions with my surgeon, Dr. Lynn D. Ketchum (who has performed the Dermofasciectomy technique on over 400 cases).

http://http://www.lynndketchum.com/surgeries.htm

I asked him how often were problems with the skin grafts and what he would do it there were a problem. His reply was that the percentage of serious problems with skin grafts was very small and in all cases the solution was to do another skin graft. No one has ever been left in "trouble".

The number one advantage of the Dermofasciectomy is the extremely low rate of recurrence (about 8%). In contrast, Dr. Eaton states on his web site that recurrence with NA is actually higher than with traditional Fasciectomy surgery which has a recurrence rate of over 40%. Since I have been a professional musician for my entire adult life (over 45 years), removal of the growths on my fingers and lowest possible recurrence rate were of utmost importance to me. I am now starting the 4th week since my surgery and I have already been able to start practicing my instrument and plan to return to working in the next few weeks. For me, Dermofasciectomy was the best choice.

01/29/07 19:25
Wolfgang

not registered

01/29/07 19:25
Wolfgang

not registered

Re: Surgery vs NA

Quote:



I've had fairly extensive surguries on both hands. ... After having gone through this twice, I realize I'd rather have had NA regularly, for the rest of my life if necessary.


Jim, after I had my first surgery I had to promise my hands that I won't have a second one. Otherwise they would have refused service ... so my decision was easy.

Wolfgang

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