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the resonse of my LA surgeon
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10/05/04 02:05
howard

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10/05/04 02:05
howard

not registered

the resonse of my LA surgeon

At least my Surgeon in LA came back to me with his response .......I will be going to Florida.

"For the early stages of the disease, this treatment looks to be as effective in the short-term and less invasive than traditional fasciectomies. HOWEVER, this treatment of limited FASCIOTOMIES (i.e. not fasciectomies) is NOT NEW. It has been described in the past and since you are only cutting (not removing) the fascia, it has been associated with a higher recurrence rate than removing the fascia as is done with a traditional fasciectomy. Based on these results presented, it is a reasonable approach for early Dupuytren's contractures but for more involved cases, I would not recommend it because of a higher likelihood of nerve injury and recurrence in MORE INVOLVED contractures.



For example the case I did this AM would have been ABSOLUTELY IMPOSSIBLE to do with this technique....it was extremely difficult to separate the fascia from the nerve with loupes and a wide open incision never mind trying to 'blindly' cut the fascia with needle swipes."





10/05/04 02:06
Randy H.

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10/05/04 02:06
Randy H.

not registered

Blind is right!

What surgeons have learned is that if you are gong to remove diseased tissue, you want to get it all. If you leave some behind, it has a higher rate of growing back. That's why limited FASCIOTOMIES are not preferred. This doc obviously assumes that NA is just like a limited fasciotomie. It's not. First, no diseased tissue is *removed* at all with NA, only severed. Second, there is little to no trauma from NA, while the trauma from a limited fasciotomie is huge by comparison. It is full "open" surgery, though limited to removing only the tissue causing the contracture. It is generally accepted that trauma to the hand triggers initial or further Dups growth. That's why if you are going to introduce trauma from open surgery you had better get *all* the tissue, because like cancer, it's not going to be too happy about what you just did to it. No so with NA. It doesn't cause trauma.

I doubt there is anyone on this forum that has experienced *both* traditional invasive surgery and NA who would not hesitate to try NA again before succumbing to the knife. Even if the reoccurrence rate is somewhat higher and faster (though that's debatable), NA recovery is a snap. As far a "blind" goes, Eaton and the French who trained him have no problem with this. This LA surgeon who is afraid of doing something "blindly" *already has*! He's written off NA without knowing all the facts.

10/05/04 02:12
Sean 
10/05/04 02:12
Sean 
NA similar to fasciotomy

Randy H.
Can't help but respond. A fasciotomy is very similar to NA. Almost no "trama" as you call it. It is an in the office procedure in which no diseased tissue is removed. The incision can be as small as 1/4" requiring maybe a stitch. Exactly the same function as NA only the surgeon sees what is being severed rather than the feel from the needle. Recurrence by almost any account is the same as for NA (and why wouldn't it be?). The recovery period is almost identical to NA. Fasciotomies are not unusual procedures. Most everyone in the medical community agrees that a limited fasciectomy has lower recurrence than a fasciotomy and NA, that is why most surgeons prefer to perform a limited fasciectomy.

Your statement, "the trauma from a limited fasciotomie is huge by comparison. It is full "open" surgery, though limited to removing only the tissue causing the contracture." This is totally a false statement, why would you perpetuate something that is 100% inaccurate.

10/06/04 02:34
howard

not registered

10/06/04 02:34
howard

not registered

I wrote the original.Could someone write a good acurate response to send to my doctor

At least his kindsa open If I could send him objective proof etc you never know maybe he will learn the operation.
is it worth reply to him?

10/06/04 02:24
Sean 
10/06/04 02:24
Sean 
LA Surgeon.

howard,
Your surgeon was correct in everything he said. What part do you have a problem? Dr. Eaton , in his information also concurs with your surgeon. I would say forget it if you have already made up your mind to go to Florida.

10/06/04 02:12
Heard Enough

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10/06/04 02:12
Heard Enough

not registered

Sean...

...you are such a weiner...

10/06/04 02:41
Randy H.

not registered

10/06/04 02:41
Randy H.

not registered

LA Surgeon

There is no possible way that NA is equivalent to limited fasciotomie, unless one believes that a needle and a knife are essentially the same thing. Eaton certainly doesn't. Limited fasciotomie is not listed as a recommended treatment option on his site, though he is fully committed to NA. Here's why you want to avoid surgery:

Dupuytren's disease occurring after a surgical injury to the hand.

Lanzetta M, Morrison WA.

Bernard O'Brien Institute of Microsurgery, St Vincent's Hospital, Melbourne, Australia.

"We report three clinical cases in which Dupuytren's disease was triggered by surgical trauma. All patients developed the contracture between 3 weeks and 3 months after operation for unrelated pathology of the hand."


Schneider LH.

Jefferson Medical College, Philadelphia, Pennsylvania.

"Dupuytren's disease presents a difficult problem that should not be treated casually. It is a continuing, unpredictable condition in which surgery is the only treatment available when contracture occurs. <obviously uninformed about NA> Surgery itself may cause an acceleration of the disease."

I'll take the needle before resorting to the knife every time.

10/06/04 02:47
jim h

not registered

10/06/04 02:47
jim h

not registered

LA Surgeon

My understanding is that when the Dupuytren's tissue is strongly attached to the surrounding tissue, NA is probably not going to give you much of a release. When there is a definite cord that's distinctly separated from the surrounding tissue, NA works quite well. The wild card is nerve involvement. If the Dupuytren's tissue has thorougly entangled a nerve, blindly snapping that tissue is probably not a good idea - a surgeon would have to open the hand and carefully remove the bad tissue while leaving the nerve intact.

It seems like most people have a fairly distinct cord that can be cleanly snapped with little risk. Others - including myself - have contractures with strong adhesions. NA could never have released my 2 PIP joint contractures. Surgery, although it was a nasty business, was fairly successful.

10/07/04 02:42
Sean 
10/07/04 02:42
Sean 
LA Surgeon

I'm not trying to suggest surgery instead of NA. I am saying that your message was completely in error. NA is a fasciotomy. It is just a form of fasciotomy using a needle instead of a blade. A fasciotomy using a blade can be nothing more than a very small slit opened enough to sever the cord. Diseased tissue is not removed as you say. Functionally it is the same procedure, that is why it is often called "needle fasciotomy". You have the terms fasciotomy and fasciectomy mixed up.

Your following statement is misleading and incorrect.
"First, no diseased tissue is *removed* at all with NA, only severed. Second, there is little to no trauma from NA, while the trauma from a limited fasciotomie is huge by comparison. It is full "open" surgery, though limited to removing only the tissue causing the contracture."

10/07/04 02:57
Sean 
10/07/04 02:57
Sean 
Fasciotomy

From Dr. Eaton's website"
What is the history of Needle Aponeurotomy?
Needle Aponeurotomy is a new twist on the old procedure of percutaneous fasciotomy. In fact, percutaneous fasciotomy was probably the first surgical procedure ever reported for the treatment of Dupuytren's contracture - before it was even called Dupuytren's. In 1822, prior to Dupuytren's 1831 presentation of open fasciotomy, the renowned British surgeon, Sir Astley Cooper wrote "The fingers are sometimes contracted ... when the aponeurosis is the cause of the contraction, and the contracted band is narrow, it may be with advantage be divided by a pointed bistoury, introduced through a very small wound in the integument. The finger is then extended, and a splint is applied...". Translating aponeurosis=fascia, bistoury=knife, integument=skin, this is clearly a description of percutaneous fasciotomy for what later came to be called Dupuytren's contracture.
In the 1800's, percutaneous procedures were were common, referred to as "subcutaneous surgery". Percutaneous release of Dupuytren's contracture was reported by many surgeons of the era, including Guérin, Fergusson, Little, Erichsen, Gant, Druitt, and others. In1879, Dr. William Adams in London published a 63 page monograph "Observations on Contraction of the Fingers (Dupuytren's Contraction) and its Successful Treatment by Subcutaneous Divisions of the Palmar Fascia, and Immediate Extension".In this, Dr. Adams clearly and elegantly describes the concept and practice of percutaneous release of Dupuytren's contracture using long, narrow scalpels, performing "multiple subcutaneous divisions of the fascia...by as many punctures as may be necessary". His descriptions of fascial releases in the palm and digits are remarkably similar to current experience with needle aponeurotomy.
In the nineteen hundreds, percutaneous fasciotomy fell out of favor as a surgical procedure, and is mentioned only briefly in current surgical texts. The reasons for this are unclear, but probably reflects the strong trend toward fasciectomy over fasciotomy in the last century. Available literature does not strongly document a clear superiority of fasciectomy over fasciotomy, and surgical practice may simply reflect convention rather than consideration, as is the case for many surgical procedures.

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removing   surgeon   limited   FASCIOTOMIES   Dupuytren   fasciectomies   fasciectomy   aponeurosis=fascia   traditional   fasciotomie   recurrence   surgical   percutaneous   procedures   procedure   surgery   fasciotomy   contracture   significantly   disease