My situation is that the Dupuytren's occurred on both hands at almost identical time (ten years ago). One hand contracted (85 degrees) and the other hand did not. After about seven years I had surgery on the contracted hand (three years ago). It is still fine. The other hand still has not started contracting and has actually gotten better since I have not been physically abusing it. Of course I realize that this could be a long (10 year) dormant period. There are just three small "dermal pits" which are hardly noticeable and functionally normal. Some time in the future I can expect another procedure, most likely.

Quicksilver,

What pinkie point was it, and what was the degree of contraction before NA? It's *great* to hear success stores, but the significance is far greater and we learn a lot more with the actual details.

The Standard Web site:

From http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=140&topcategory=Hand

Treatment Options: Surgical

Surgery for Dupuytren's contracture divides or removes the thickened bands to help restore finger motion. Sometimes the wound is left open and allowed to heal gradually. Skin grafting may sometimes be needed. Risks of surgery include injury to nerves and blood vessels and infection. Some swelling and soreness are expected but severe problems are rare. A physical therapist may be helpful during your recovery after surgery. Most people will have improved motion in the fingers after surgery. Surgery does not cure the disease, which tends to progress gradually and recur over time.

Research on the Horizon/What's New

Experiments are being performed with enzyme injections that may be able to break down the tough bands and improve motion without surgery. Early results are promising, but these injections are not available for general use at this time. <END>

What's missing here?........Any mention whatsoever of Needle Aponevrotomy.

Information about Collagenase is fairly widespread. Every surgeon that I've heard about is *awair* of the promise of Collagenase and views it *favorabily*, whereas NA is still pretty much in the Dog Pound. This make no logical sense to me because the Collagenase and NA procedures are practically *identical*. The only difference is that *one* uses an injected enzyme to weaken the Dups cord before it is severed by external stretching, while the *other* uses the mechanical action of a needle. The amount of diseases tissue that Collagenase "dissolves" is minuscule compared to what is left in the hand, just enough to break the cord. That being the case, can anyone explain to me why the anticipated rate of recurrence for *both* of these procedures should be *any* different whatsoever?

You see, we've been discussing the fact that the higher assumed recurrence rate for NA is the *main* obstacle that must be overcome for it's acceptance as a standard Dups procedure. However, the same surgeons who must be convinced concerning NA are seemingly already on board with the *idea* of injecting an enzyme that will do the exact same thing as NA. What's up with that? What am I missing here.

Sean,

If you are correct, why all the *buzz* about Collagenase? Why is Collagenase mentioned as "promising" on the Dups discussion of the official web site of The American Academy of Orthopedic Surgeons? They all know about the fasciotomy, and as you point out, CHS do the fasciotomy. It's nothing new. If a fasciotomy is really just the *equivalent* of the Collagenase injections, why did BioS spend a *fortune* trying to get it FDA approved. And why is the new owner of the technology apparently gearing up to finish the job (Great!). And why would all these surgeons be leading them on all these years just to create the chemical equivalent of a simple fasciotomy?

Sean, you need to call these guys *right away* and tell them to stop wasting their time and money!! :-)

No, I don't think so. Collagenase treatment *can't* be the equivalent of a fasciotomy.

But you've go me off point. The point is: Why is the surgical community excited only about Collagenase, when NA effectively does the same *exact* thing. That's what's puzzling me. If *not* the same thing, what's the effective difference?

But good point. I'm now planing on asking Eaton myself abut what he considers the difference is between NA and a fasciotomy. He should know. He's done more of both than anyone.

The argument regarding fasciotomy has been discussed repeatedly on this web page, most frequently in the past by Gary, who oddly enough had the same exact opinions as Sean, references the same texts, writes in the same manor, etc. etc. etc. Must be conjoined twins separated at birth.

Some fellow board posters asked their doctors about this procedure and got responses such as 'Haven't heard of it', 'don't do it', etc. etc. The claim that it's practice is wide spread, claimed repeatedly by Gary when he wasn't busy insulting those enthusiastic about NA, has never been documented or proven.

Anybody that cares to take the time to go through the past several years of postings will find this out for themself.