Hi, I hope this post is allowed as there seems to be a feeling that Needle aponeurotomy is not available in the UK either privately or on the NHS. This is not the case.

I have been doing palmar cases for many years and now do finger ones as well. There is certainly a reluctance among many surgeons because they have not seen the results. However I am more than willing to see patients both privately and on the NHS at the Pulvertaft hand Centre in Derby.
www.hand-surgery.co.uk

Hello Chris,
It is so good to hear from you. If you had the time to search these posts you will find that there have been notes of someone in Derbyshire doing NA on the palm. However, requests for details from both the BSSH and the NHS resulted in nothing, nada, zilch. We are also aware of someone at the Royal Free Hospital in London who has performed NA.
I have checked your web page and, the powerpoint on Dupuytrens, although interesting, does not give any details or pictures of your use of NA. Would you be willing to update your powerpoint for the benefit of those in the UK who are desperate for non-surgical treatment?
Many of us from the UK go to other European countries for our treatment and, the practitioners there are amazed that the offer of free training in NA at the Laraboisiere hospital in Paris has not been taken up. I went for treatment three weeks ago to Dr Jean Luc Lermusiaux and he told me that no-one has yet made any contact with him or his colleagues.
You will, I am afraid, find that the mantra of those of us who have NA treatment is 'Paris Trained' and this is also the case in the USA.
Once again, thanks for your post and lets hope that other surgeons follow your lead. It will be some time before there are enough practitioners in the UK to deal with all those who would benefit from NA rather that surgery. None of us are getting any younger and 'popping over to Paris' will not always be possible.
Marjorie

Hi

I haven't been to Paris as personally having read the papers and having done NA in the palm for 15 years I did not see the need. Having done probably in excess of a thousand open dupuyten's cases I reckon i know where the band are pretty well.

I have corresponded with Dr Eaton on a number of topics over the years and certainly have been impressed by his approach. I personally think that collagenase will replace NA within the next 3 years for the vast majority of cases and that Dupuytren's open surgery will cease to exist.

Chris

Hi

Yes I was one of the advisers to NICE when they brought out there documentation. At the time I only did palmar aponeurotomy but having reviewed the literature I saw no obvious reason for not doing it in the finger and said so.

The net effect of that was to get me into trouble with my colleagues who felt I was promulgating dangerous ideas.

Personally I never believed that fasciectomy was the answer and moved to smaller segmental fasciectomy many years ago for the vast majority of patients. I actually tried to obtain collagenase 20 years ago in this country but could not find a company willing to produce it to an acceptable standard for in vivo use.

I don't know of anybody else in this country who does needle aponeurotomy, but I think we will creep out of the woodwork over time.

Chris

Frances

I am not sure what you mean? I am a fully trained Consultant Hand and Plastic Surgeon working at the largest Hand Surgery centre in the UK and one of the biggest in Europe.

We run training courses on all aspects of Hand Surgery for General Practitioners, junior surgeons and Senior Surgeons.

NA is not a complicated procedure, it is probably the simplest procedure I do. The only thing stopping every hand surgeon in the UK doing it is a belief that it does not work, lack of training is not the problem.

After all NA takes 5 minutes, does not involve a significant anaesthetic and is pretty safe compared with other techniques. Any surgeon who does open fasciectomy knows where the cords are, what a spiral band looks like and where the nerve is likely to be.

What you need to ask your surgeon is "What percentage of your practise is hand surgery and how many open fasciectomies have you done." if the answer is >50% hands and over 100 fasciectomies he/she is trained to do NA.

Apart from the Paris team who have now gained a vast experience in this I would not go to anybody, wherever they trained, who did not fulfil the above criteria.

I am sorry to sound arrogant, I regularly travel to see people from whom I can learn (twice to the States this year at my own expense)however on this occasion I do not see a need to train for something for which I am already overtained.

Chris