The following is a quote that I have posted many times in the past. However, with the unorganized manner of this forum's topics, I have no idea where it is in past topics. I pulled my huge dog-eared notebook with many years of notes, websites and research on Dupuytrens out. This may be helpful. The site is http://www.ccmbel.org/History.html
and it is a combined history/treatment posting for Dupuytrens. At the bottom, in the conclusions section is the following:

"without clear answers to these questions, the surgical approach of Dupuytrens disease has swayed from the very simple closed fasciotomy to the very aggressive radical palmar fasciectomy. The less traumatising techniques were often found insufficient to correct the contracture and to bring lasting improvement. The more aggressive operations were developed on the unfounded hope that recurrences could be avoided. This has never been proven and these techniques were responsible for a great number of complications."

This was published prior to NA being performed in the US. It is comparing a "traditional type" (my words) fasciotomy with a fasciectomy. Fasciotomies were the "first" surgeries/treatments for Dups. They are much the same as an NA procedure. The "closed fasciotomy" is much the same as NA, but utilizing a scalpel instead of a needle. The "open fasciotomy" is more of a surgery, where flaps of skin are cut so that it is not a blind procedure as NA and a closed fasciotomy are. This writer's conclusions (again prior to NA being performed in the US) was that these techniques "fasciectomies" were responsible for a great number of complications.
In the case of my husband, and others that I know and/or have communicated with, they experienced their nerve damage from fasciectomies, not from NA.
Hope this helps someone have a little more information that they may be seeking.
The fasciotomies were gotten away from because of recurrence, which we all know can be common with NA as well. How much of a problem it is varies from one sufferer to another.

I emailed a Hand Surgeon at Kaiser to ask him about NA as an alternative to OS and the segment in paranthesis below is his reply to me. I was wondering if anyone has heard of someone experiencing tendon damage as a result of NA??


(I have no personal experience with this technique but on Wednesday of this week I am doing a tendon reconstruction on a patient who had a needle aponeurotomy with Dr.****. THis is a disastrous complication and I would not recommend the technique. In general, Kaiser will not refer to an outside surgeon for a problem that can be taken care of within our system. His technique is far from well accepted and is not done by any other hand surgeons I know in the bay area.

Please let me know if you have other questions.)

I do not necessarily believe Tricias story however my first question would be, did this supposed severing of a tendon occur at the hands of an Paris-trained NA practitioner or a self-taught doctor?

Person of Concern

You are correct---it was very odd to get such an email from this surgeon. Especially in this litigious society. I continue to be disturbed by how shut down and closed most US surgeons are to any kind of alternative to OS. We continue our support of NA. In fact, my partner is scheduled to have NA on her left hand this Thursday. I am still interested in finding out---has anyone out there personally experienced a tendon problem following NA?

She had OS on her right hand in 2003 and it was not a very pleasant year for her following it. In fact, while she is severely impacted with dupuytren's in her left hand, we have been on a search ever since for an alternative to OS.

We have interviewed many surgeons and have never felt comfortable with their lax attitudes. I have been conducting research to find an alternative to OS and have had emails with the Paris Clinic, with Dr. Eaton, with Dr. Pess, with Dr. Barry, and Dr. Denkler.

The doctor who will be performing the NA this Thursday has asked her permission to have a film crew document the NA procedure. She has agreed in hopes that NA can become a viable option in this country.

I will post the results of how the NA goes on Thursday. If Thursday is a success for her left hand, and the doctor determines her right hand to be a NA candidate (remember she had OS and sometimes this can interfere with being able to have NA due to scarring), then she is already scheduled for the 29th of December for her right hand.

Please hold the collective positive thoughts for her Thurday, (as well as for all the other individuals who have dupuytren's.)

Just wanted to let you know I am leaving for Paris on Friday. I will be visitng with the French NA originators next week.
I have been thrilled with the results of NA so far.
The current offering for Dupuytren's surgery is a radical one, fasciectomy, by essentially all hand surgeons.
NA offers a simple, expeditious, procedure with dramatic improvement under local anesthesia as an office procedure.
It will be hard to convince the bulk of the CHS that this "blind" procedure has merit and should be the first offered to the patient, rather than a major invasive surgery.
Like the data previously published by the French rheumatologists, and by Dr. Foucher, the complication rate is very low. I did re-explore a patient, under local anesthesia with nerve injury "numbness" I alluded to in a different thread. There was no nerve transection, only a poke from the needle, with the sheath being intact. A nerve "poke from a small needle should heal just fine. I don't know the final result yet, but nerves in the finger regenerate, it just takes months.
Surgery itself, has nerve damage rate of about 2-3% and a much higher rate, perhaps 15-20% in surgery for recurrent disease.
Most Dupuytren's, especially in the palm is central. The nerves are lateral. Staying superficial and central protects the nerves from damage.
During surgery, of which I have done hundreds, bad things can happen. Nerves can tear, or inadvertently be damaged dissecting off the this gristle like Dupuytren's cords.
The biggest problem for NA is lateral disease especially around the middle (PIP) joint where the nerves are very superficial. Plus PIP joint disease may have Dupuytren's posterior to the neruovascular bundle and a blind, deep needle relase in this area is too dangerous.
Overall the results are very good for MCP disease, fair to good, occasionally great for PIP disease.
I do think hand therapy is good for PIP disease since static and active correction and prevention of contractures is necessary.
Ketih
PS I do think radiotherapy has some value and I applaud Wolfgangs efforts. I think the fingers should be as straight as possible first.
I also await the release of Cordase, but I cannot get this and it is not out yet for use by physicians outside of clinical studies.