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2nd time around
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03/23/2005 23:30
michael 
03/23/2005 23:30
michael 
second

tom,
you need to get a life.

03/24/2005 23:12
Randy H.

not registered

03/24/2005 23:12
Randy H.

not registered

Crazy-Making Logic.

Sean, there may *not* be that big a deal. Here is one man's opinion:

"Technically speaking, Needle Aponeurotomy is a type of procedure referred to as a percutaneous fasciotomy. "Percutaneous" means going through the skin with the smallest hole possible, and "fasciotomy" means cutting fascia, which is the layer under the skin affected by Dupuytren's disease."-Dr. Charles (Charlie) Eaton.

"In the nineteen hundreds, percutaneous fasciotomy fell out of favor as a surgical procedure, and is mentioned only briefly in current surgical texts. The reasons for this are unclear, but probably reflects the strong trend toward fasciectomy over fasciotomy in the last century. Available literature does not strongly document a clear superiority of fasciectomy over fasciotomy, and surgical practice may simply reflect convention rather than consideration, as is the case for many surgical procedures." <END>

If true, that's a bit sobering considering the following:

"<Open> Surgery may actually aggravate the process, and patients may be worse off after <open> surgery than they were before. Complication rates following surgery have been reported in the range of 17% to 41%. Complications are nearly twice as common following repeat surgery than for primary surgery."

So, anyone here reporting Complications form NA? Anyone? Going Once.......Going Twice.......

AND NOW, THIS JUST IN::

Schneider LH, Hankin FM, Eisenberg T.:

"While helpful in the early care of these patients, the open palm method does not modify the long-term results in Dupuytren's disease, which is a pervasive condition *without* a *simple* *surgical* solution."

Earth to Schnieder.......Earth to Schnieder, OVER........
You're breaking up. You last transmission appears to be in error!! Please report to Earth for further instruction.

Sean, YES *both* Collagenase injections and NA *are* fasciotomy procedures. One "percutaneous" the other "percutaneous + biochemical." Still, no one can tell me why the surgical community is calling one "promising" and the other useless. This is crazy-making logic.

03/24/2005 23:04
jim h

not registered

03/24/2005 23:04
jim h

not registered

information

Functionally, a fasciotomy, a needle aponevrotomy and Collagenase injections accomplish the same thing - they sever the band. They differ in the particular skills and knowledge required, in the amount (and possibly persistence) of 'gap' they produce in the cord, in cost, risk, and in the amount of corollary damage.

Where I think the surgeons have let us down is in understating the amount and importance of the collateral damage caused by an invasive procedure like a fasciotomy or fasciectomy. If you leave that out of the equation, surgery looks like the best choice, being a more complete and (arguably) permanent solution. But if you consider the real after-effects of surgery, it's a completely different story.

Although the fasciotomy requires a comparatively small incision, it's still a surgery.

And my opinion is that we should all just forget about Collagenase because it's not going to happen for at least another 5 years, if ever.


03/24/2005 23:31
Sean 
03/24/2005 23:31
Sean 
information

This is information from Dr. Eaton's website:


Fiber fasciotomy in Dupuytren's contracture]

[Article in Russian]

Shaposhnikov VI.

42 patients with hand Dupuytren's contracture were operated. Transection of each finger scar cords was performed in transverse direction through 3-8 skin punctures from proximal portion to distal segment in the zone of middle phalanx base. In addition, complete finger extension was achieved on operating table. There were no recurrences in follow-up of 13 years.

03/24/2005 23:36
Sean 
03/24/2005 23:36
Sean 
more information

This also from Dr. Eaton's website, nothing new I guess.

There is a general tendency for surgeons to recommend minimal surgery (e.g... fasciotomy) for early disease, fasciectomy for established disease and more aggressive surgery (e.g... dermofasciectomy) for advanced or recurrent disease 6529287. Final outcome after surgery is worse in patients who have an earlier age of onset, severe PIP joint involvement, and small finger involvement 1284016. Surgery is usually recommended when MCP contractures progress to 30 degrees, when PIP contractures develop 1769986, or the patient develops a positive "table top test" 7060997, as shown here. Needle aponeurotomy may be performed when the fingers can't be lifted from a tabletop; open surgery is reserved for contractures which prevent the palm from fully contacting a flat surface:

03/24/2005 23:28
No Name

not registered

03/24/2005 23:28
No Name

not registered

Surgery Profile

Sean,

That's an interesting posting and accurately describes cases like mine where surgery is required. My case is aggessive and these stats are interesting.

Sometimes surgery is the option. Although, I'd prefer not if given the chance.

03/24/2005 23:53
Sean 
03/24/2005 23:53
Sean 
Conclusion

I agree. It just depends on the individual. I have been reading many studies today which analyze the different situations. If DD is observed early, results are good for NA in many instances. The more complex the situation (or absence of a well defined cord), the more likely a limited fasciectomy is the preferred treatment.
The information is fluid and I'm sure that Dr. Eaton's experience will have an influence in defining when the different procedures will be most appropriate.

03/25/2005 23:37
Senor Ultimo

not registered

03/25/2005 23:37
Senor Ultimo

not registered

NA only answer to DC

fasciectomy is never the preferred way to go, only go for NA.

03/25/2005 23:35
Randy H.

not registered

03/25/2005 23:35
Randy H.

not registered

Complimentary Procedures

Sean,

I think your last point is a good one. It's *way* too soon to accurately predict where NA will eventually wind up on the informed surgeons' tool belt. But just the fact that this little procedure from France seems on course to have it's day in surgical court should excite anyone who has a stake in this, patients and care givers alike. It's just another tool, like Collagenase, with "Promise". But, it's here now!

However, we sometimes discuss the NA/Open Surgery question as if it were an "Either / Or" decision. Does it need to be? Why can't it become a "Both / And". What I mean by this is the idea that in any case where NA might be of benefit, why not give it a try before moving up the scale of invasiveness? If, as in the case of No Name, the predicted outcome would only be rapid recurrence requiring open surgery, what is lost by trying NA first? Like Taxes......file for an extension!! Who knows, the disease might decide to take a year of two (or more) off. Meanwhile we buy time toward a cure. And what if NA can bring a 90 degree contraction back to 45? Wouldn't it be better to start open surgery at 45 than 90? Or what if NA can *completely* correct one finger while another needs OS? 50% is better than nothing.

This is *completely* uncharted territory, as NA still has a *long* way to go before it's added as an accepted convention to our traditional mix of interventions. What I am suggesting, though, is that OS and NA perhaps need *not* be looked at as "competing" but *complimentary* procedures. Each doing what it does best. NA either eliminating the need for OS, postponing it, or perhaps softening up the ground before bringing in the OS invasion, inevitable in some cases

03/25/2005 23:14
No Name

not registered

03/25/2005 23:14
No Name

not registered

NA or OS

Randy,

I agree completely with your last posting and I think it is the best way to view NA or OS as treatment options. My DC is progressingly very fast, but for DC sufferers with more gradual progession your suggested path could make sense. If you're like me, I'm not sure, but who knows.

I went from initial signs of DC to surgery in three years and its progressing quickly in the other hand. Would NA slow it down is a good question, but I think if others are as afflicted by DC as I am, they should give serious thought to OS. As I have mentioned, my surgery went well and the recovery was not that bad. But, while surgery may be the best option for some, it should not be rushed into. In fact, my surgeon encourages delaying surgery as long as possible.

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rate-of-progression   progression   cmd=Retrieve&db=PubMed&list   Surgical   procedure   degrees   different   ID=140&topcategory=Hand   Dupuytren   rate-ofprogression   surgery   treatment   procedures   Collagenase   fasciectomy   fasciotomy   because   contraction   recurrence   uids=3968392&dopt=Abstract