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Less Invasive Surgery
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Eddie 

Eddie 
less invasive surgery

As I understand, these are the currently used types of surgery, starting with the least invasive :

1 NA :
( my apologies to some if I put this as a surgery :) )
perforation of the DC cord using a needle, separation of the cord through traction. No removal of diseased material.

2 fasciotomy :
single, straight cut of the DC cord, no diseased material removed

3 segmental aponeurectomy :
'several' small cuts in the cord, partial removal of diseased material

4 (dermo)fasciectomy (radical or limited)
zigzag cuts, attempting to remove diseased material as much as possible.
Some possible variations are :
- how far to go in removing diseased material
- use of open palm technique (avoid infection, draining wound, avoid haematoma )
- use of skin grafts, when e.g. when skin healing problems are expected, and/or to avoid recurrence at the same spot (like second surgery on PIP joint)

5 amputation
last step, when finger is bent too(?) far, or after too(?) many surgeries

Now, also to me there still remain a lot of questions.
In many places, you read that fasciotomy is only applied for elder people, because of the high reoccurrence rate. If this is because the diseased material is not removed, why isn't it valid too for NA , and to a lesser extent, to
segmental aponeurectomy ? I have seen figures of 40 to 60 % for both NA and fasciectomy, but none for fasciotomy. It seems to me there are just not enough (correct) figures to judge reoccurence.
And, who can state that reoccurence is solely depending on the type of surgery ? Personally I think that the patients own 'DC-type' is more important.

Apart from surgery, some other treatments have been mentioned :
- cortisone injections (generally accepted to slow down the DC when applied in an early stage in 'some' cases)
- local application of vit E, verapamil, DMSO...., from which some people claim they have some improvement
- acupuncture or other traditional chinese medicine
- maybe in future : the collagenase injection

Btw, I am not going to take part in those silly yes-no discussions that seem to take up a lot of space in this forum !

Jan

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Jan

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less invasive ~sq~surgery~sq~

Tom, that was so funny, you made my day!

Eddie 

Eddie 
less invasive ~sq~surgery~sq~

Gary,
It was not really meant to be a preferred order.
As I said in here before :
- there is only one thing clear about DC, and that is 'nothing is clear about DC'.
- people seem to react differently to different types of 'surgery' (I include NA here)
- what we end up with, is not necessarily the (direct) consequence of the 'surgery' we had. We don't know what is the result of the surgery, and what is due to the progression of DC in our hands. This without forgetting that several people seem to agree that any type of trauma (including surgery) might accelerate DC.

Some small remarks :
- on DC surgery being 'relatively minor' : maybe technically it is, but look again at what I wrote in the paragraph above.
- not getting much attention in the medical world : am I wrong if I assume that the description 'Dupuytren' is relatively new ? (in the medical world, 30-40 years is new!). Looking back, I realised some members in my family (grandparents, granduncles) probably had the disease, but it was just called 'a form of arthritis', or reuma (or just old age ?). We are not going to start again here about the money-part, right ? .

From all I think I learned about the subject, I couldn't really advise anybody what treatment to choose.
Personally, next time I think I need something to be done about my hands (which could be read as having a contracture of about 30 degrees), I would start looking at NA (easy for me to say, since I live in Europe). Though first I would like to know more about what happens with the non-removed diseased tissue. ( is there anybody who reads this who can answer that ?)

I suppose making a choice is kind of a gamble.

So, we gamble, and we win or lose .......

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Surgery   contracture   Fasciotomy   surgeon   progressively   procedure   understanding   immobilization   diseased   bow-stringing   Invasive   material   technique   information   Aponeurectomy   fasciectomies   fasciectomy   ~sq~surgery~sq~   recurrence   interposition