San Francisco based TV Channel 7 just ran a short segment on needle aponeurotomy on the 6:30 evening news showing Dr. Keith Denkler of Larkspur performing NA on a patient who later extolled the virtues of NA. The segment was part of a regular segment of the news hosted by Dr. Dean Edell, a popular TV and radio talk show physician who answers questions on many medical problems.

The fact that Dr. Edell hosted this segment and endorsed NA will be a big boost in bringing this new and wonderful procedure to the ultra-conservative medical community. I expect we will now see a number of West Coast residents visit Dr. Denkler, and I will look forward to hearing reports back from them.

Bob

And so the anti is upped for the long time NA supporters who believe French Training is imperative. Denkler is not a CHS and has *not* as yet been trained in NA by........well, anyone but himself. He will tell us that an "needle release" is no big thing for a plastic surgeon. And he may be right. He is a surgeon after all, and most of the French NA practitioners aren't.

Why this is important to those of us in North America? If Denkler can get the same low rates of nerve damage and do the good PIP releases that Eaton has done, then as Walt Stag. joked on his filmed French procedure, "I could learn how to do this." On the other hand, if NA has some tricks of the trade that the French have figured out over 30 years, something could be Lost In Translation without some guidance.

What to do? Not much but watch and see what happens. If the NA movement that was started on this site over three years ago is to succeed, at some point it will move far beyond the ability of any of us to control. Does it really need our help any more? Can we trust the idea that: "Nothing can stop an idea who's time has come."??

I don't know the answer, but generally I'm excited about the new TV exposure.

Randy and Frances, thank you for you comments and I am glad you enjoyed the video.

For clarification, I am CHS although in a unique category. I successfully took the CAQHS exam in 1992 as I qualified by my broad hand case load and hand fellowship training. In 2002 when it came up for renewal, I did not renew as my case load currently in hands is mostly Dupuytren's, trauma, and some rheumatic hand conditions.

I will be going to Paris in November, 2005 and visiting with the French needle rheumatologists, the originators of NA. I am looking forward to it!

Mostly I am glad to get the video out and it does live on the internet at:

http://abclocal.go.com/kgo/health/edell/071105_edell_bentfinger.html

Keith

Dr. Dinkler,

According to both Dr. Eaton and Dr. Press, the input from the French is worth it. Thanks for taking the recommendation of many on this Forum and taking the time and effort to go have a look. Thanks also for your savvy to get the attention of Dr. Dean Edell. I have not been able to get the video to run, but I'll take Anon's word for it. Also, thanks for clarification of your qualifications. It certainly looks like you are becoming the West Coast Go To Guy for NA.

How many hands have you treated with NA?
41 digits so far and growing

Do you keep track of your DD patients progress after you treat them. Yes, as I am collating them for presentation at next years plastic surgery meeting.


Have you had any patients who have nerve damage from NA?
Just had my first one. A patient who had two previous surgeies on this finger and had MCP and PIP joint disease.
He is coming back for a nerve repair next week. He was warned re: the risks of nerve injury with NA in the face of two previous surgeries. He is glad to have the finger straight and that he did not have to have it entirely re-opened for surgery. The nerve I will repair under local anesthesia and magnification through a 1/2 to 1 inch scar.
The Dupuytren's literature reports a high incidence of nerve damage with recurrent surgeries.
In the literature, some authors divide the rate for surgery on primary versus recurrent disease and others may divide the rates for digital arteries and nerve transection. McFarlane[41] reported an overall digital nerve or arterial injury rate of 3%. Tubiana reported a digital nerve injury rate of 7.1% in 195 fasciectomies and did not mention digital artery injury. Orlando, Smith and Goulian reported a digital nerve injury rate of 4% in 128 digits and did not report digital artery injuries. Sennwald reported major differences between digital nerve and vessel injuries in primary versus recurrent disease. In primary operations, the rate of nerve or vessel injury was 3.9% of hands. For recurrent disease, it was 57.7% of hands. Roush and Stern reported an 11% incidence of digital nerve injury in surgery for recurrent disease.

Therefore, the results of nerve damage in primary, repeat NA operations , and repeat NA procedures post open surgeries will need to be tabulated for comparisons to open surgery. NA in virgin Dupuytren's should have much lower nerve damage in general and probably lower than open surgery. Time will tell. No nerve damage in virgin Dupuytren's yet as the nerve locations are more predictable!

Do you treat PIP contactions of the little finger, as I have? Yes.

Keith