Jane, although we cannot give medical advice and suggest to rely on the recommendations of your doctor, here are some aspects for consideration:

- surgery will likely cause at least scarring (and maybe other side effects that we decribe on our web site) and the comment of your doctors is the state of the art with regard to surgery.
- radiation therapy is most effective in the initial stage and then has a chance to eliminate a nodule completely. But radiation therapy is, at least to our knowledge, hardly available in America.
- NA is usually also only applied on a major contraction. While NA rarely conflicts with later surgery, it at all, scarring due to surgery might render later NA impossible. It might make sense to try NA before undergoing surgery. Both both only when you have considerable contrcation.

Wolfgang

Jane,

I am 56 years old and had a nodule in my palm for 20 years. Contracture started to occur 12 months ago and my doctor gave me no indication that what I dad was Dupuytren's and that it is a disease and that it is progressive, sometime progressing slowly and then accelerating rapidly. The contracture in my left hand progressed at a gradual rate over the past 6 months to a stage I level. while my right hand which had the first nodule in the palm did not show signs of contracture until 3 months ago but was progressing much more rapidly.

Due to the delay in treatment from the mal practice efforts of my "primary care physician" my only options for treating the contractures was surgery, and then my decision became which one. Had I known at the time that I had a progressive disease my decision to have radiotherapy would have been a no-brainer, regardless of where I had to go to get it.

I had a NA procedure performed by Dr. Denkler, a unusually enlightened and progressive medical practitioner, especially rare in the USA with our health care culture and the AMA, and now am scheduling radiotherapy in Essen, Germany in an effort to halt the disease.

Before coming across this forum and the information posted here and references to other data, I was scheduled for a fasciectomy by a well regarded CHS who also teaches at Stanford Medical, and who still uses traditional tourniquet procedures which are known to present significant and unnecessary risks for the patient, both during the surgery and with post-operative complications.

Bruce

Dave,

The CHS (certified hand surgeons) doctors in the USA to which I have spoken downplayed the problems with complications but studies show a 19% rate for all hand surgeries in several studies I found that dealt with a very large number of patients (over one thousand).

"Complications that may occur from traditional surgical methods used to correct Dupuytren's contracture - such as nerve injury, infection, hematoma formation, stiffness, flare reaction or RSD (Reflex sympathetic dystrophy)..."

RSD, nerve injury, hematoma formation, and similar complications are the result of the tournequet and the loss of blood flow to the arm and hand for a period of 90 minutes on average. Dr. Denkler, who in addition to performing NA procedures, also does traditional hand surgery, and has review over 3000 surgeries where a arterial clamping procedure was used instead of the traditional tournequet for the entire forearm and hand. This alternative procedure is rejected by the majority of hand surgeons in the USA, but Dr. Denkler found none of the problems attributed by these surgeons in the 3000 cases he examined.

Add in the risk of nerve damage from the surgery and the risk of infection which in rare instances can even lead to amputation, as well as the general risks of undergoing full anesthia, and approaches like a fasciectomy lose a lot of their appeal (except for the surgeons earning a living performing these operations).

There are alternative tournequet procedures that various hand surgeons have been recommending including one that uses two tournequets, but the hand surgeons in the USA are extremely slow to seriously consider, much less adopt, new approaches.

The first hand surgeon I saw recommended a fasciectomy and said NA would result in recurrence within 2 years. He made no mention of the risks of hand surgery and in fact stated that the problem with NA was a high risk of nerve damage. My readings indicate the opposite, that the risk of nerve damage is much lower with NA than with a fasciectomy or similar hand surgery.

If I have learned anything through this process it is to distrust in general the opinions of doctors and to seek to validate information on both the probable success, side effects, and odds of recurrence of various treatment options.

Bruce

Bruce,

Many thanks for your very informative reply. It seems that you have sought and aquired far more detailed information than many of us would think we needed to know, and here lies part of the problem. I knew nothing of Dupuytren's, beyond that it was, in my case inherited and that it was progressive. I was not told about any treatment other than surgery, so did not think to ask. I was told I would have a Brachial Plexus Block and a tournequet and was given an outline of the surgery involved. I am an engineer, why would I question any aspect of the procedure?

I saw a member of the surgical team for a check up at 11 weeks post op. and when I mentioned NA he simply smiled and said "Where did you hear about that?". Apparently NA was not an option for me and of course I'm in no position to challenge his medical expertise.

It is true that greater knowledge allows us to make informed choice but in the end, don't we have to rely on others and hope for the best, although I can see that relying on 'hope' is a pretty desperate state of affairs.

Thanks again to all those like yourself who provide answers to the questions we never think of asking.

Dave