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aponeurotomy in the US
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07/26/2006 23:18
Ira Plotinsky

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07/26/2006 23:18
Ira Plotinsky

not registered

aponeurotomy in the US

Can anyone tell me where in the U.S aponeurotomy for Dupuytren's Disease is performed. I am particularly interested in information about California.

Thank you

07/26/2006 23:54
SusieQ 
07/26/2006 23:54
SusieQ 
M.D. List-Needle Aponeurotomy

Ira - I e-mailed you the list of M.D.s known to us on this Forum.

Feedback on the both of the California M.D.s has been quite positive.

Susan

07/27/2006 23:21
Dr. Larry Berryman

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07/27/2006 23:21
Dr. Larry Berryman

not registered

California NA

I am sure that the Docs in California are doing good work, but if you want the most experienced NA surgeon in the US, by far, it is worth the trip to Jupiter, Florida to see Dr. Eaton. I would not trust my hands to anyone but him. He is an accomplished and skilled hand surgeon with a wealth of experience with Dupytren's.

07/28/2006 23:44
Randy H.

not registered

07/28/2006 23:44
Randy H.

not registered

Another View

Dr. Larry,

There is no question that Eaton has tremendous experience and is leading the charge for NA in North America. However, your post could be interpreted to imply that his level of experience is necessary for an American trained CHS to be *completely* safe and effective with NA. Perhaps if NA were experimental, or required in-depth training, this may be true. Remember, the originator of NA and most European practitioners are not even surgeons, let alone top notch CHS.

As a CHS, Eaton had the confidence to do his first NA with no instruction *whasoeve*, other than seeing a simple video. Eaton refers to NA as a "rather crude" (but effective) procedure. He has no misgiving about simply doing an NA seminar for his fellow CHS and turning them loose. None.

True enough, NA on a MPC is far easier than on a PIP (further from the palm). Training and experience do count for more in that case. However, the second most experienced NA practitioner does live in CA.

If NA is to take off as we all need it to, at some point we'll need 100+ CHS on board. Personally, I had a great experience with Eaton. He is the Father of American NA. I also feel that very equivalent treatment is available elsewhere as well, given the simplicity of the procedure and skill level required of CHS.

As an MD it would be interesting to hear your critique of my point of view.

07/29/2006 23:11
diane 
07/29/2006 23:11
diane 
NA in California

No doubt there are more people with this disease than Dr. Eaton alone can treat and for many, the travel is just not feasible. I chose to see Dr. Denkler in California because it was half a day's drive, but, more importantly, because he took the time to review my photos and make thoughtful comments. Denkler says he is up to 400 procedures and thats a pretty good number. So don't hesitate to use one of the other practitioners on the list if it works out.

07/29/2006 23:38
Luba M.

not registered

07/29/2006 23:38
Luba M.

not registered

NA with Dr. Denkler

I had a surgery scheduled for Aug. 11th after being told by three surgeons that it was the only way to treat my PIP joint of the little finger, that was bent almost 45 degrees....Thanks to the different websites I found on NA and because of the positive reports I read on this forum about Dr. Denkler, I decided to email him pictures of my hand. He immediately called me back, and said he could help me....
On 7/24/06 I drove to his office and had the procedure done....my finger is now straight and after almost a year, I am finally able to put my hand flat down on a table....
I cancelled my August surgery and am thrilled that I will not have to go through all the pain and therapy involved in OS....
I am so happy to have found this forum ....and I am so grateful to Dr. Denkler....he is warm, caring and professional.....I hope that many more Drs. in the U.S. will be trained in NA in the future....it can save you alot of pain associated with OS.

07/30/2006 23:18
Alan

not registered

07/30/2006 23:18
Alan

not registered

wrap-up from Wikipedia

From Wikipedia, the free encyclopedia


Dupuytren's contracture is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended (straightened). It is named after the famous surgeon Baron Guillaume Dupuytren, who described an operation to correct the affliction.

The ring finger and pinky finger are the fingers most commonly affected, but Dupuytren's contracture may affect any or all of the fingers. Dupuytren's contracture progresses slowly and is usually painless. In patients with this condition, the tissues under the skin on the palm of the hand thicken and shorten so that the tendons connected to the fingers cannot move freely. The palmar fascia becomes hyperplastic and undergoes contracture. As a result, the affected fingers start to bend more and more and cannot be straightened.

Incidence increases after the age of 40; at this age men are affected more often than women. After the age of 80 the distribution is about even.


Risk Factors
Regular operation of heavy machinery increases one's risk of developing Dupuytren's contracture; family history, diabetes, liver disease, alcoholism, epilepsy and pulmonary tuberculosis are also factors. Surgery of the hand may trigger growth of Dupuytren nodules and cords if an inclination existed before. Dupuytren's contracture may accompany fibrosing syndromes such as Peyronie's disease, Ledderhose's disease and Riedel's struma.

Those of northern european descent are markedly ar risk. Margret Thatcher is perhaps the most famous patient. Interestingly, although this a predominantly caucasian disease, many carribean blacks can present with contractures, and all can trace a distant relative to England or Ireland.


Treatment
Surgery (in cases of severe contracture removes the contracture)
Radiation therapy (specifically in early stages inhibits development of contracture)
Needle aponevrotomy (releases the contracture)
Triamcinolone (kenalog) injections provide some relief
Surgical management consists of opening the skin over the affected cords of fibrous tissue, and dissecting the fascia away. The tendons can then be brought out to length. The procedure is not curative, and patients may need re-do surgery, however, the thickened fascia often invests the digital nerves and arteries, so there is significant risk of de-vascularization of the digit.

Treatment of Dupuytren's disease with low energy x-rays (radiotherapy) may cure Morbus Dupuytren on a long term, specifically if applied in early stages of the disease. Needle aponevrotomy is a minimal invasive technique where the cords are weakened through the insertion and manipulation of a small needle. Once weakened, the offending cords may be snapped by simply pulling the finger(s) straight. The nodules are not removed and might start growing again. Currently in phase III of Food and Drug Administration (FDA) approval is another promising therapy, the injection of collagenase. This procedure is similar to needle aponevrotomy, however the chords are weakened through the injection of small amounts of an enzyme that dissolves them.

07/30/2006 23:41
Bergie

not registered

07/30/2006 23:41
Bergie

not registered

Calif

Can anytone tell me where Dr. Denkler is located?
Thank you.

07/30/2006 23:15
Luba M.

not registered

07/30/2006 23:15
Luba M.

not registered

Where is Dr. Denkler located?

Dr. Denkler is in Larkspur, CA...about ten minutes north of the Golden Gate Bridge in San Francisco....phone # (415) 924-6010....website www.aestheticsurgery.com

07/30/2006 23:29
Margie

not registered

07/30/2006 23:29
Margie

not registered

Pictures

The website with pictures of NA by Dr. Denkler is:

http://www.plasticsurgerysf.com/scrapbook/

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