I agree. We who live in California are lucky to have Dr. Denker.

Dear Dr. Denkler,

I am curious...how many patients with DD have you treated with NA? I plan to be one of your patients when and if my finger bends again.

Frances

The last known post from the real "Francis" was done 2/02 under: "colchicine and acetyl-l-carnitine working still" The post was as follows.

"Yes, I have picked up an Internet stalker and haven't posted as _______ in a long time. All those posts under my name are his even if they look like my style because he has copied it to fool you....so I've changed my name and been laying low...the times I have posted, I have been careful to not use my usual style."

Look at the context. I believe this was authentic and not the impostor. That being the case we can ignore anything further posted as "Francis". Also, the impostor is easy to spot be it never adds anything to the discussion, only mimics what others have been saying.

Thank you for all of your support as this site is a great public forum for the disease we call Dupuytren's.
In terms of my own pratice of NA, my numbers are small for Dupuytren's, numbering only about a twenty, since I am a recent convert to NA. My uses of needle releases for trigger fingers, scars, joint release, and tendon releases over the past fifteen years number about 200 cases in addition to hundreds of surgeries I have performed for Dupuytren's over this time.

To help you understand my evolution you must understand I have been working diligently to get patients out of the hospital for this procedure. I started my work on Dupuytren's under local anesthesia as an office procedure more than 12 years ago. Since then I have been trending more and more to smaller surgeries and smaller incisions to decrease the impact and recovery to the patient while achieving improved function. Most hand surgeons are reluctant to do these Dupuytren's surgeries without a mechanical tourniquet. I prefer to use a chemical tourniquet, epinephrine (adrenalin)in my local anesthetic instead. At the American Society for Surgery of the Hand meeting in September I was part of a study of 3000 surgeries of the hands and fingers, including Dupuytren's using local anesthesia with epinephrine rather than a mechanical tourniquet. Publication in the Journal of Hand Surgery should be later on this year or next year. Hopefully this will allow more patients the ability to have sugeries in the office and save the hospital and anesthesia expenses for multiple types of hand surgery, not just Dupuytren's.

I plan to do many more NA since the results are so dramatic and the morbidity is small. You will be able to see my technique and results on TV in March 2005 and you can judge for yourself. After is is broadcast you can go to www.KGO.com and search for my name or Dupuytren in Channel 7.

I have also been a big fan of segmental aponeurectomy since that removes a segment of the disease. It will be interesting to compare if removing a segment of the diseased tissue (SA) is better than NA in terms of preventing recurrence. This pits Belgium, Dr. Moermans, www.ccmbel.org/These.html against the French connection of Badois and company. Time will tell which may be better and a true comparison will take a long time. I know they both work well.
When Eaton publishes his data on NA, perhaps more doctors will take notice.
Keith

Eaton is correct in the sense we don't know about recurrence. How to even define it among hand surgeons is in dispute. Is it recurrence of disease, extension of disease, or is it new disease? These are some of the questions.

From a patient standpoint, improving the ability to straighten the fingers is what we can do an should do. Optimally we should not only staighten fingers, but keep them straight. In the days of Dupuytren and without anesthesia, a simple fasciotomy was reasonable. However, with the development of improved anesthesia techniuqes we as surgeons trended to more radical techniques such as the extensive fasciectomies recommended by McIndoe. Due tot he extensive morbidity and complications surgeons have trended to more limited fascictomies with or without skin grafts. Their seems to be delay in recurrence Dupuytren's with skin grafts, but skin grafts increase patient morbitidy.
Two popular techniuqes are fasciotomy and fasciectomy. They have not been compared head-to-head. If they were compared, should the fasciectomy be limited or more extensive in removing disease and contracted cords. These studies are for the future and are hard to set up. It would take a lot of patients, randomization, and long term follow-up.
The books teach excision, not release of the tissues. I believe the general feeling of surgeons is that cutting out the tissue will help prevent recurrence and that is why they do it and that is what they were trained to do. Having done both, I love the simplicity and recovery of NA.
Keith