After being diagnosed with DC, I am most impressed with the information and feed back on treatments and results for DC.
I would appreciate any feed back and details on the Paris Clinic, with recommendations from those who have been treated and their results.
Would enjoy another trip to Paris, for treatment and another romantic experience!!!

I finally received a reply from Dr Hunter-Smith and he sent me a General Information Letter which I will share with you below. I've already booked for Paris but his might interest others.

Dupuytren’s Letter (18/04/2006)


Thank you for your enquiry regarding Needle Fasciotomy for the treatment of Dupuytren’s Contracture.

I am a Reconstructive Plastic Surgeon with a special interest in hand surgery and microsurgery. I have been in private surgical practice for 11 years. I work pubically for the Peninsula Health Care Network at Frankston Hospital and Rosebud Hospital, and work Privately through my offices in Mornington. I operate Privately at Beleura Private Hospital and The Bays Hospital Mornington. I am a Fellow of the Royal Australasian College of Surgeons and a Member of the Australian Sociecty of Plastic Surgeons.

Dupuytren’s contracture is a disease that can usually be controlled but not cured. Traditional surgery involves the removal of the disease (fasciectomy) and reconstruction of the skin either with Z-plasties (local flaps), or skin grafts (usually full thickness)

A fasciotomy is a procedure designed to divide the Dupuytren’s band or cord, without removing it. Fasciotomies have been performed for decades. The French have devised a novel method of dividing the fascia using a bevelled needle (needle fasciotomy).

This procedure has been used extensively throughout France and Europe and has gained some popularity in the United States.

I was introduced to this technique by a patient who had travelled to see Professor Badois in Paris. He had had a successful release of his Dupuytren’s band using the needle technique.

His disease had recurred and he sought treatment locally.

I investigated the technique and read the available literature. It must be emphasized from the outset, that treatment with needle fasciotomy has a higher recurrence rate than traditional surgery.

I have been performing the “needle fasciotomy” technique now on selected cases since February 2004. I believe that this procedure is most suited for patients with slowly progressing disease that is predominantly affecting the metacarpophalangeal joint (knuckle), with little or no disease of the distal digit. It works best for an isolated Band of Disease in the palm to one or two digits.

I have treated over 30 patients and have been pleased with the results. At this stage I have had no nerve complications. I have had two patients that have had significant skin splitting, requiring skin grafting to these splits.

My routine practice is to splint my patients post-operatively for a few days and I recommend that patients have follow up hand therapy by an accredited Occupational Hand Therapist.

During the healing phase, the scar tissue that forms between the two ends of the divided band, may lead to an early recurrence. Because of this it is important to wear a night splint for three months.

Disease that is rapidly progressing, involving the skin, and/or extensively involving the proximal interphalangeal joint (middle joint of the finger) are usually not suited for this technique.

I have performed the procedure both in the office setting under local anaesthetic, and in the operating theatre with regional or general anaesthesia.

I plan to visit either Paris or Florida (Dr Eaton) in the next 12 months but at this stage have not made a formal date to do so.

Please find enclosed information regarding making an appointment and an estimate of costs for treatment with needle fasciotomy.


Yours Sincerely,



David Hunter-Smith.

































If you wish to proceed with making an appointment with Mr Hunter-Smith you will need a referral from your General Practitioner.

There currently is a 5 – 6 month wait for an Initial Consultation. Our contact phone number is 03 5976 3522.

The usual procedure is for you to have a consultation with Mr Hunter-Smith and then book any appropriate surgery at that consultation.

If you are travelling from Interstate, we may be able to book you in for a consultation and the procedure at the same time, but request that you forward on a brief history and current photographs of yor hands via e-mail. We can then get back in contact you regarding a date.

An estimate of fees is as follows:

Initial Consultation (104) Subsequent Consultation (105)

Fee: $125.00 Fee: $70.00
(Medicare Rebate: $62.95) (Medicare Rebate: $31.60)
(Out of pocket: $62.05) (Out of pocket: $38.40)


Estimate for Surgery (per session)

1. In rooms

Theatre Fee: $250.00
AMA (46366): $285.00
Total Fee: $535.00

(Medicare Rebate: $94.10)
(Out of pocket: $440.90)

Hand therapy: Initial consultation - $60, Subsequent consultation - $50,
Splint approximately $60
(Some of these costs may be refundable if you have Extras on your Private Health Insurance.)

2. Operating Theatre

David Hunter-Smith – Will bill health fund direct with patient gap of $400.00
Anaesthetist – Approx $335.00 (out of pocket approximately $150.00)
Hospital Fees – Any excess applicable on your level of cover is payable on admission.

Hand therapy: Initial Consultation - $60, Subsequent Consultation - $50,
Splint approximately $60.
(Some of these costs may be refundable if you have Extras on your Private Health Insurance.)


Ancillary procedures such as skin grafts or formal treatment may incur further expenses.

Off to Pa

The whole spread of NA outside of Europe has been almost entirely patient driven. Dr. Keith Denkler, who is now #2 behind Eaton with about 350 procedures, learned about NA right here on the Forum.

It's exciting to learn that a form of NA is being done in AU. I say a "form" because the feedback loop from the patient is critical to avoid nerve damage. This will be explained to Hunter-Smith when he goes to Paris. (Eaton still will not instruct personally.) His current approach explains why he feels NA is far more limited than all the other practitioners do.

The PIP *is* more dangerous because of the nerve bundles, and I did need to tell Eaton he was close to a nerve. Without patient feedback like this, Eaton would not continue to have zero nerve damage in 2,500 procedures. Without instruction, Hunter-Smith's work will not be as safe *or* effective as it could be. Unlike Eaton, both Press and Denkler have given personal instruction.

Dear GMB,
Great to hear your news though as Dr L treats me I am not surprised at the outcome. What did surprise me was that you drove, from where to where?, in Paris!!! Nobody drives in France, they just aim at the nearest opening with their hand on the horn and pray. Try using the metro and trains next time, no problems and always on time and safer.
Brilliant news,
Marjorie