It's been quite awhile since I have posted and I have to admit that I only visit the forum about once per month to read up on what's being discussed. While I think debate of procedures along with helpful advice is great, the personal arguing gets old after awhile. That having been said, my husband and I owe much to this forum. It was here that we learned of NA and where it was performed. We learned much about nodule injection, collagenase injections, topical verapamil, lecithin (sic?) etc. The different stages and recuperations of others was always interesting and thought provoking in trying to determine the best options for his situation.
Richard has had four limited fasciectomies, nodule injections with kennalog, one NA in Switzerland and went to Stoneybrook for an interview for the clinical trials for collagenase injections. (He was accepted, but due to the distance from our home, he declined when we realized how frequently he would have to make the trip). Initially his first and second limited fasciectomy appeared to be successful to us as far as release of contracture. He had hard recuperations and much pain, but his fingers were much straighter and more usable. The problem, for him, with the limited fasciectomies was that at about a two year out period, the fingers would be contracted to about one-third to one-half of what they were pre-surgery and becoming worse rapidly. The last two limited fasciectomies did not give nearly as much straightening as the first two, but more pain and slower recovery periods. With the help of a poster we met on this site, he secured an appointment with Dr. Rappoport and we went to Switzerland in the summer of 2003 for NA. The NA was less invasive and less pain and less recuperation time than the limited fasciectomies had been, but due to scar tissue some of his cords were really accessible to the procedure. Still we were grateful to Dr. Rappoport who did a lot with a little to work with. Unfortunately, the rapid recurrence caused contracture to return. (A quick interjection, it was approximately 2 years ago that we found a Dr. to inject his nodules with Kennalog, which caused them to soften and flatten, to a point of almost gone. Not completely gone, but a major reduction. That was very helpful to him as they caused him pain when trying to open jars, doorknobs, etc.)
A few years ago, prior to making the trip to Switzerland, I had spent many hours reading this forum and researching everything I could find about any and all procedures available. (Well, not a few things that were pretty obviously snake oil, but any that seemed viable). I had read about Dr. John Hueston's dermofasciectomies and had found Dr. Lynn Ketchem's website and his treatments utilizing nodule injections and dermofasciectomies. We knew that if Richard ever decided to have surgery again that we wanted to see Dr. Ketchem, but at that point he was not desiring another surgery and particularly the recuperation. With that in mind, he went the route of injections and NA. After his recurrence, it finally reached a point of revisiting surgery, but our feelings were basically, "what we've done hasn't worked, try something else" and Dr. Ketchem's site seemed to support a dermofasciectomy for very advanced/aggressive cases of Dupuytren's. We visited him last summer and found him, his staff and the residents training with him to be a great group of people. His knowledge and the surgery he explained seemed to be the answer to our prayers as what was explained was along the lines of what our extensive research supported.
So, one month ago, the time was right and he had a dermofasciectomy performed by Dr. Ketchem. Unlike in the past, the surgery was not extensive, in that there was not the attempt to aggressively remove all of the disease. Instead, sections of cord were removed in each of his four fingers (not thumb which was not contracted) and on each side of the palm. These were then covered with skin from the upper part of his arm. One week ago his stitches were removed and I'm happy to report that his fingers are much straightened and the skin grafts had "taken" well. The pain and recovery have not been bad, though not a cakewalk, but definitely not bad. The degree of contracture is much more reduced than it was from the last two surgeries. Dr.
Ketchem injected a nodule that had become quite large in his other hand and it has greatly reduced in size and has softened considerably. When we went back for stitch removal a week ago, he injected a nodule in his foot, Ledderhose, and it is decreasing as well. Interestingly, he said that the feet nodules will usually respond better than the hand nodules, so we're very hopeful about that.
I hope that nothing in this post has been offensive or anything that will cause argument. (I have argued myself, in the past. This type of disease is very personal and evokes strong feelings from it's sufferers).
I think that dups sufferers are more fortunate today than they have ever been. Here on our own land, you can choose injections, NA, fasciectomies or dermofasciectomies. While my husband definitely had a better time with some procedures than others, each person's case is different. Good luck to all.
Mary Beth

Tommy,
It could have been him since he has had painful injections. As he worded it, "It's bearable but it does hurt." I guess because the nodules are so hard. His have always started reducing within about 1-3 weeks with good results by 1 month or less. It probably is different for different people since this disease is so unpredictable.
Good luck,
Mary Beth

Does anybody know the appropriate ICD-9-CM codes for a Dupuytren's contracture dermofasciectomy?
It appears the codes would be:
82.35 Other fasciectomy of hand
Release of Dupuytren's contracture