Bill,

That's a reasonable question, as it is well known that multiple Open Surgerys become more difficult and less effective due to the inevitable scaring that results from an invasive procedure. However, the 25 gauge NA needle in the right hands is like a laser "Smart Bomb" that takes out it's target with minimal collateral damage. One month after my NA there was no trace on my hand that anything had been done (except that my finger was now straight)

Dr Eaton:

"What happens to the cord after it has been cut? The cord is softened and digested by the body's normal enzymes, and heals in a lengthened state. The cord is a normal structural layer which has become wider and shorter from the effects of Dupuytren's. It is not a tumor - it does not have to be removed, and when it is returned to it's proper length, it becomes hard to feel - just like it was before Dupuytren's affected it."

Inasmuch as past scaring can *prevent* NA, and that NA can be done almost *indefinately*, it would follow that if NA does create actual scaring, it is so minuscule as to be imperceptible.

Nancy may have seen Dr. Kline's site on my (so far) final version of the updated list of M.D.s offering N.A.

I reviewed some web sites and included the two I thought might be of most immediate help as references on N.A. specifically.

Here' s the list:

LIST OF DOCTORS OFFERING NEEDLE APONEUROTOMY* TREATMENT FOR DUPUYTRENS CONTRACTURE IN U.S. (Updated 12/11/05)
please let us know of any corrections or additions

FOR INTERNATIONAL DOCTORS PERFORMING N.A. see: http://perso.wanadoo.fr/f.badois-dupuytren/html/liste.html

*(N.A. is a minimally invasive outpatient procedure for Dupuytrens which effectively breaks the cords which cause contraction of the fingers, thereby releasing them. The procedure has been available in France for many years with an excellent safety record and was introduced in the U.S. in 2003 by Dr. Charles Eaton. Since then a number of other doctors have begun offering N.A. to their patients as an alternative to open hand surgery.

Drs. Eaton and Kline both have informative websites (see below). Dr. Eaton's site contains some information which is more technical, and Dr. Kline's own experience with Dupuytrens adds a personal touch.)

KEY: FT = FRENCH-TRAINED

Charles Eaton, M.D. and Paul Zidel, M.D. (FT)
CERTIFIED HAND SURGEONS
The Hand Center
1002 Old Dixie Hwy, Suite 105
Jupiter, FL 33458
Phone: 561-746-3420
http://www.handcenter.org/newfile16.htm

David Kline, M.D (FT)
BOARD CERTIFIED EMERGENCY ROOM PHYSICIAN
Dupuytren's Clinic
Holy Rosary Medical Center
351 SW 9th St
Ontario, OR 97914
phone: 208-344-5628
http://dupuytrenscenter.com/

William Bourland, M.D.
CERTIFIED HAND SURGEON
The Hand Clinic
1068 Cresthaven Road, Suite 400
Memphis, TN 38119
Phone: 901-259-1600
bourland@orthomemphis.com

Keith Denkler, M.D. (FT)
CERTIFIED HAND SURGEON
275 Magnolia
Larkspur, CA 94939
Phone: 415-924-6010
info@aestheticsurgery.com

Gary Pess, M.D. (FT)
CERTIFIED HAND SURGEON
Central Jersey Hand Surgery
2 Industrial way West
Eatontown NJ 07724
Phone: 732-542-4477
handman@doctor.com
http://www.centraljerseyhand.com/dupuytren.htm

Prosper Benhaim, M.D.
CERTIFIED HAND SURGEON
(does NA in Los Angeles, CA)
Contact Information:
Hand Center: (310) 794-7784 Information and referral
(310) 825-7001 Information

Terrence J. Barry, M.D. (FT)
ORTHOPAEDICS BOARD CERTIFIED
3802 NE 207 St #2302
Miami, FL 33180
Phone: 305-822-6000
Fax: 305-557-5904
Drtbarry@aol.com

To fellow NA advocates:

I am *very* encouraged after my meeting with one of the leading CHS in the United States, a former President of the American Society of Hand Surgery. A year earlier he was very dismissive of what he called "that needle thing". Though he's not going to be preparing a 25 gauge syringe with numbing agent anytime soon, his attitude was *remarkably* different, even before I showed him the hand Eaton had worked on......."Which finger was it?" he asked.

WHICH FINGER WAS IT (!!!) I guess I've forgotten. It looks almost normal now, without a trace.

After examining it a bit he measured and pronounted it had a 5 degree bend, down from 30. He wanted to know how long it had been. "3/4 of a year. Are you concerned about recurance?"...."Yes" he replied. I showed him where the bump above the PIP had dissolved after NA hand snapped the cord. So far, so good. Turns out he had been at a small local conference that morning and the subject of NA has been raised. I told him that Eaton will hopefully be making a report at their next convention and recommend he attend. "Yes, I will. We are keeping an eye on this".

"WE ARE KEEPING AN EYE ON THIS!!!" Remember, this guy is within a *handful* of the most respected CHS in the county. He's gong to Eaton's presentation.

Then this: "Considering your unusual swelling reaction to surgery, I'd recommend you personally avoid OS and continue with NA as needed" He warned that Eaton, with 1,300 procedures under his belt would be safer than someone with only "five or so". While that *is* true, there may be some skepticism that maybe Eaton is a freak of nature and his zero nerve damage results aren't repeatable by others.

He agreed that without good 5 year recurrence data, we really don't know what we've got here. However, I pointed out that recurrence should be the same as with Collagenase. While his facial expression showed a certain lack of enthusiasm for that statement, he really didn't have much to say about it.

So, while the professional concerns of recurrence and nerve damage are still at hand, I think my doc's more Open Minded attitude regarding NA *may* be representative of the larger profession. We've created some buzz here folks (Oh, with just a *little* help from Eaton):). CHSs are watching. Hopefully, as Eaton predicts on his web site, "It's only a matter of time".

Good show, Randy.

Thanks for sharing that encouraging report.

A good-sized chink in the armour appears.

Cheers

Sam,

Necessary for what?