Carl, the issue with NA is that the Dupuytren cord keep growing. By the time the patient decides for surgery it might have become fairly big. For having surgery I don't think there is much difference between previous NAs and a situation where the cord has developed to the same size without NAs. Of course NA causes a break in the cord and therefore the cord might look a little different but NA doesn't do other scarring. Scarring is what makes repetitive surgery difficult.

Wolfgang

I've had 2 fasciectomies, one on each hand. They both worked, to the extent that some straightenig was achieved and progression in those areas stopped. But there was some permanent collateral damage: a cut nerve and some loss of ROM due to scarring, despite intensive physical therapy. An attempt to straightent a pinkie PIP joing left the finger a mess, permanently at 45 degrees and with very little ROM left.

I this discussion is miminizing the downside of surgery. Besides the damage, recovery is extremely tedious and can take up to a year. Endless changing of dressings, soaking and exercises during the first months after surgery. For those of us who like to stay in shape - no serious exercise for months. Try driving one-handed, or showering with one hand held above your head.

Surgeons never see this dark side. 3 months after the surgery they look at the wound and say "it's healing fine". By that point you're thinking NEVER AGAIN.

I would have to be in really desperate shape before I'd have another surgery. Agreed that some MDs seem to be setting extremely high rates for NA, but I hope that will change as more get into the game.

Jim,

Quite right.

The reason 350 CHS recently had a seat and listened to 1 1/2 hours of discussion of OS *alternatives* is exactly as you say. The reason Collagenase was developed for Dupuytren's is, again, exactly as you say. Fasciectomies can be problematic, as shown by 5% rate of Major Complications found in the study summarized under "Finally a Controlled study". The Surgeons who perform Fasciectomies are concerned about this or 350 of them would not have been wasting their time.

These CHS were told that NA is far safer than OS, and given sufficient data to support that claim. The only challenge to what Eaton's team was saying concerned *recurrence*. Are NA's advantages worth the trade off of it's higher probability of recurrence? Quite obviously the vast majority of posters here are convinced it is, at least for them personally.

But for the majority of CHS to add it to their general "ladder of treatment", they are going to need that minimum five years worth of well collected recurrence data. One lecture isn't going to change 50 years of medical tradition overnight, especially with that data still pending.

So, in lieu of that eventual data, the argument of Eaton's team went something like this: "Given the increased risk over NA, recovery time, cost, and the fact that Fasciectomies have >50% recurrence rate *themselves*, what is the downside of trying NA first?

We'll see who listened. Their names will probably wind up here :-)