hmmmm after reading up on all the comments here about Dr Denkler.... maybe I ought to go to him instead of Dr Eaton now ????

Have had surgery on 3 fingers of left hand hand on 11/22/05 in Seattle, WA.
Fingers started bending immediately after surgery.
Have had therapy for 6 months-
Am now tryng SERIAL CASTING to try to prevent further bending and HOPE fingers will STAY in a straighter position. This is working for now.
This is all very exerimental as therapist has not tried this before with DC patients.
This is being done with my CHS approval, of course-
So far fingers are responding but what will happen after no more casting is done ????

In the meanitme my other hand is bending again so I'm due to go see Dr Eaton for yet another NA on the right hand (will be my third NA)

Perhaps I should just go to Dr Denkler and let him look at bnoth ahnds and see if he can help me further.
I feel that the PIP joint in the left middle finger is FROZEN- maybe he can help me with this.

I'll consult and report back. I must add that I also am a type II diabetic PLUS I have a blood disorder (low white platelet count- also immune related !).

my case is unusual and most difficult I'm told
LUCKY ME.:<) Feel free to email me if you would like more details or pictures. Thanks for any suggestions on what I need to do next...
I'll do ANYTHING to avoid more surgery- It was the most horrible experience of my life.

Diane encouraged me to make some comments.
She had recurrent Dupuytren's complicated by a skin scar band. If the finger had NA and was straigntened the scar band would tear uncontrollably or it would inhibit extension and hurt the final result.
Using local anesthetic with epinephrine I did a z-plasty release to allow more skin into the area when the finger is straightened. Though that incision I was able to go in and excise some of the deeper retrovascular Dupuytren's cords that would be impossible to treat with NA and would have limited the improvement by NA alone. So far she has had a nice result. Treating PIP joints is difficult, both with NA and with surgery. In Diane's case a combination technique proved to be the best solution.

She had NA, segmental aponeurectomy a la Moermans:

http://www.ccmbel.org/These.html

and a Z-plasty closure to recruit more skin for extension.
Combo therapy can be very useful and combines a surgical approach in difficult areas for NA, plus NA can be used in areas where it works the best ie palm and MCP (first) joint area.
All of this can be done under local anesthetic with epinephrine and without the need for a tourniquet or hospitalization or general anesthesia, a technique I have previously published:


Dupuytren's fasciectomies in 60 consecutive digits using lidocaine with epinephrine and no tourniquet.

Denkler K.

Department of Plastic Surgery, University of California, San Francisco, San Francisco, Calif, USA.

Dupuytren's contracture is a common hand problem. Its treatment, other than percutaneous fasciotomy, is an outpatient operation performed with the patient under regional or general anesthesia. If local anesthetics are used, they are used without epinephrine, and an arm or forearm tourniquet is essential. Multiple reviews have described the safety of local anesthetics with epinephrine in the digits. This study is a retrospective review of operations performed by the same surgeon in the hospital (43 digits) versus the office using local anesthetics with epinephrine and no tourniquet (60 digits). Results and complications were compared and tabulated. The hospital and epinephrine groups were comparable regarding preoperative measurements. Postoperative improvement in extension at the metacarpophalangeal and proximal interphalangeal joints was similar in both the hospital and epinephrine groups. Complications, including digital nerve and artery injuries, infections, and hematomas, were similar between the groups. There were no cases of digital necrosis or gangrene in the epinephrine group, even though one patient sustained a transection of a digital artery at the proximal interphalangeal joint. Because of the similarities in results and complications, there does not seem to be an advantage to performing Dupuytren's excisions with full arm tourniquet and outpatient admission in many cases. Local anesthetics with epinephrine are safe in the treatment of Dupuytren's contracture, although both the use of digital epinephrine and the use of mechanical tourniquets carry the potential for complications. Visibility is similar to that for facial or head and neck surgery and is aided by the use of loupe magnification. The old dogma against its use in the fingers is refuted, as seen by the results in these 60 consecutive Dupuytren's fasciectomies and the results of other authors.

In regard to Randy's question:
I may be more aggressive, but I have a lot of experience with surgery and with NA, much like most other practitioners of NA in the United States. They both have their advantages, however I mostly do NA at the present.
I may be able to help some NA patients via a semi-open approach esp. around the joints and esp. with lateral disease. Posterior, or retrovascular disease, is a problem with NA, since we approach the cords from the palm and to get posterior cords, the needle would damage the nerve and blood vessel.
Frances: I did surgery and NA in one session, under local.
Miriam: Serial casting is a good idea. Therapy in cases like yours is a great idea. The fact that you are having poor results with NA and surgery is most likely due to your underlying disease, and so far we have no solution. Collagenase might be the best solution, but I have no idea when that will be out.
Good luck to all and I am going to post on Imiquimod (aldara ) also.
Ketih

Dr - I echo Frances' comments. Thank you so much for your openess. I have had NA 3x (2Eaton, 1Pess, soon to have another with Dr Pess) thanks to this website and to the open minds of all of your colleagues. I shudder to think what I would have had to had done 5 years ago.

Since I have severe PIP involvement, I am very interested in your combo approach for PIPS. Keep up the good work! I'm also very interested to hear your thoughts about Imiquod (sp?).

.

Ellen - I am interested to see that you have had NA with both Drs. Eaton and Pess and are going back to Dr. Pess. I am in NJ, was thinking of Dr. Eaton, and just heard of Dr. Pess and think I will go to him. I had fasciotomy 3 years ago, and NA sounds more appropriate for me. How has your experience with Dr. Pess been?