Well put Wolfgang. You've just about made a response to Sean unnecessary. Well.............almost.

Sean,

Your assertion that CHS aren't particularly interested in a far less invasive procedure is based on the idea that they have always had the less invasive fasciotomy, but prefer fasciectomy anyway. While fasciotomy is less invasive than fasciectomy, it is still an "Open" procedure. NA and Collagenase are less invasive still. Fasciotomy uses a knife, the others a 25 gauge needle. Not the same.

If they *were* the same, why then all the fuss about Collagenase? Why then, as Collagenase has stalled, do we see a quickly growing number of CHS who, once they see that NA is for real, are becoming advocates for it? Eaton has essentially given up his usual practice to help get NA accepted in the US because, as he put it, "Somebody had to do it". You can agree to disagree with Eaton, Zidell, Press, and Denkler as to the argument that something *other* than Open Surgery is desperately needed. They sure seem to think so.

Where we do agree is that the actual recurrence numbers of NA Vs fasciectomy will tell the tail as to whether NA should become the commonly accepted first attempt at treatment. Admittedly, the Official Jury is still out. But Eaton's short term results on 1,300 procedures is looking very good.

Sean says that of the the thousands of Dupuytrens' surgery performed yearly, there are only 5 complaints and they appear on this forum. This is simply not true. First of all, recovery periods are drastically different. Open-hand surgery can result in recovery times of over 4 months with extensive therapy (The Indiana Hand Center, which does not do needle aponeurotomy, indicates that splinting might be necessary for 6-9 months). Recovery time for needle aponeurotomy is less than 14 days. In my case I was driving the next day, using both hands on the computer 3 days after the procedure and returned fully to work 9 days later. Furthermore, as local anesthesia is used, the risks of general anesthesia are avoided. The risk of complications (nerve damage, loss of blood circulation, skin damage, infection, loss of mobility, hematoma, bone loss) during and following surgery has been estimated at 20% (Sibbit and Sibbit, 2001). This reference is used often by hospitals that perform surgery and do not do the needle procedure. Complication levels this high have not been reported for needle fasciotomy. I am not a physician, but it seems to me that the only issue to be addressed is one often cited by Randy, i.e., is the recurrence rate higher with NA?

Steve Abrams

Steve,
You say, "Sean says that of the the thousands of Dupuytrens' surgery performed yearly, there are only 5 complaints and they appear on this forum."

The correct quote below, is much different than what you attributed to me. I didn't say there were only five complaints.


I said, "But out of the thousands that are done every year in the U.S., there are maybe five on this forum complaining about surgery."

I fully understand the differences of the procedures. The different choices are great. There are trade-offs that each person needs to make in order to decide which procedure is best. For me, it will be difficult decision, considering the success I had with a fasciectomy.

Of course the recovery time will be different depending on how severe their DC is (more than one finger, degree of bend, size of nodules etc...) For one finger with a severe bend it took me about 3-4 days for the swelling to go down and most of the pain to leave. However, it was still sore enough where certain things were still kind of hard to do. The time you can go back to work depends on what work you do. If your work requires one to do strenous work with their hand it could take between 3-5 days, if your requires little or no strenuos work with your hand one could actually go back to work the next day. However, I would at least take one day off and let the swelling go down and soreness to disapate a little. I had my NA on Oct.19th and today I have no pain. My treatment was on a Wendsday and I was back at work the following Monday.

Sean, nobody should feel bad if he/she decides for surgery. If you have a doctor who does excellent fasciectomy, if you already have experienced good results, i.e. you know that you won't get swollen hands or an increased rate of Dupuytren, then why not have fasciectomy? Well, maybe except for the pain after the surgery.

I don't think that overall recurrence rates will be a good guide to choose between NA and fasciectomy. It is logical that a technique that removes the diseased tissue has a lower probability of recurrence. For NA I actually consider the term "recurrence" as a little misleading because the cord is not removed and, of course, it will keep growing. Why should it stop? But if NA can postpone a surgery by 10 years or so, it might buy a lot, provided surgery doesn't turn out well for you.

As with all Dupuytren therapies the best choice depends on your personal constitution. If you for example know that for yourself fasciectomy triggers agressive Dupuytren, then it nearly rules out fasciectomy. But if you know that it works well for you, hand surgery might be a good choice. Yet a 2nd surgery on the same finger typically is already tricky, even for experienced surgeons. Therefore I personally would still rather avoid fasciectomy as long as possible. Would I have severals NAs before I surrender to surgery? A good question. Does anybody know whether several NAs result in such thick cords that they become difficult to operate? I have no idea and maybe we have not enough experience yet, but comments would be interésting.

Wolfgang