Hi Dr Chris,
Methinks you have opened a can of worms. So much effort has been put into trying to find someone in the UK who does NA that no-one can quite believe that you exist. The consultant hand surgeon I saw dismissed NA out of hand, said it did not work and that no-one with any sense would do it. After two solid years of many people trying to find a practitioner of NA in the UK you have suddenly crept out of the woodwork. I think that you are very brave and good luck to you. Your hand surgeon colleagues are behaving in a very precious way and it needs someone like you to show them the light. Perhaps you know of a hand surgeon who would be brave enough to go to Paris for training and set the ball rolling. We know NA works, you know it works, the sceptics need convincing.
Marjorie

Dr. Bainbridge,

It's always a pleasure to have a surgeon post to this Forum. It's great that the Web will now connect you and more of your countrymen who prefer to try NA.

You expressed a stronger hope for Collagenase than we have heard previously. In as much as NA and Collagenase do pretty much the same thing (one mechanically one bio-mechanically), isn't it correct to assume that it will have the same issues with recurrence as NA?

Having personally had a very difficult time with fasciectomy, I am no more a fan of the procedure than you. However, it seems to be the thinking of American CHS that when NA leads to multiple *quick* recurrences, fasciectomy is the next step. Why do feel Collagenase will be more effective than NA and/or do you believe that rapid repeated ongoing Collagenase is preferable to an Open procedure in neatly all cases? Making Limited Fasciectomy a "thing of the past" is a tall order. How is that possible?

Hi Frances

Thanks for the reply. I can see where you are coming from in the States and your system is of course far less regulated than ours. $700 per finger would be a dream for me. Basically I work like the guys at the Mayo on a salary from my employers. I am so busy that I have a 6 month wait for surgery. Even in my private work (1 evening a week) I have a waiting time of 6-8 weeks for surgery.

However I am interested in this and we are aiming to be the lead british centre for the collagenase studies. I am interested in anything that increases the reputation of the unit I work at, Pulvertaft hand centre, named after Guy Pulvertaft one of the original pioneers in hand Surgery who helped train many of the present senior american hand surgeons.

I think you perhaps can see that we are substantially different over here. The volume of work is very different. I saw 5 dupuytrens patients among 25 patients in this mornings clinic. We did NA on 2 (one a recurrent after fasciectomy 10 years ago), booked one for a fasciectomy, one for the collagenase trial and 1 is coming back for NA at her next visit. This is my average volume in the 2 new patient clinics I do each week.

Chris

Hi Marjorie,

Seeing a British list is a beautiful thing. Congratulations on you good work. Frances

Hi Marjorie, the hospital might be named "Broomfield" instead of "Brownfield". Stuart Flemming's name is sometimes spelled with Fleming, maybe that's also part of the problem.

Do you have any further information on "Mr. Harvey"? I failed to locate him, too, unfortunately.

Wolfgang