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.

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?

...you are such a weiner...

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.

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.