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the resonse of my LA surgeon
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10/07/04 02:59
Randy H.

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10/07/04 02:59
Randy H.

not registered

Equivalent Vs Superior

Fine,

If anyone has felt mislead, please read the discussion by Eaton that Sean has so kindly posted. Eaton is *The Man*

Now, again, the issue is whether or not NA is really just the equivalent of limited fasciotomies, or where it is significantly superior. If Eaton (who should know better than anyone on the planet) felt they were equivalent, he may as well be doing limited fasciotomies on all these folks flying in from all over the US. No, instead he went to the trouble of traveling to Paris for NA instruction. If he thought it a dangerous "blind" procedure, he could just as well cut open the hand for a better inside view (limited fasciotomie). He doesn't. In fact, the first time he actually saw NA performed in Paris his reaction was "Remarkable"! Why? Is it because it's really just the equivalent of limited fasciotomies? I think not.

The argument Sean is making is that because NA is so similar to limited fasciotomies that the rate of reoccurrence will be similar when compared to the superior rates from Traditional Invasive Surgery. The numbers we have so far don't bear that out:

http://www.dupuytren.org/html/gbefficace.html

I suggest that the reason for this is that NA is significantly less traumatic than limited fasciotomies. The trauma / Dups relationship is real. Do the least traumatic thing to your hands as possible. BUT, lets suppose that at the end of the day the French data is WRONG and NA's rate of reoccurrence is *twice* that of surgery . Even then, let those among us who have had *both* procedures tell us what they recommend. (I'll personally be in that camp soon myself. Now proaching 30 degrees. Wish me luck.)

10/07/04 02:18
Don Westin

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10/07/04 02:18
Don Westin

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Randy and Sean

You guys are great! You should take it on the road..."The Randy and Sean Show". CBS might pick it up for a late show. Much of what I know came from your debates, guys. Without you we would be wandering without a clue. I just want to thank you and ask you to keep it up. Great show, y'all.

10/07/04 02:52
Sean 
10/07/04 02:52
Sean 
Fasciotomy

Randy H.,
You are still missing the point. You said, "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."

In a fasciotomy there is not a removal of the diseased "tissue causing the contracture" (or the cord). A fasciotomy is the cutting of the cord, the same as for NA. NA is a fasciotomy. There is nothing "huge" in the difference between the two forms of procedures. I am not arguing or discussing the merits of one or the other.

In a fasciectomy, the diseased tissue is removed and is a much more involved surgery.



From Dr. Eaton's website:
"Recurrence is a problem with any treatment, but is more likely following NA than surgery."

10/07/04 02:10
ANON EMUS

not registered

10/07/04 02:10
ANON EMUS

not registered

Gary/Sean

Sean,

I returned to the forum after a months absence and can't believe you are still at it. You, as usual are here not as a contributor, but as an antagonist.

No one believed you as Gary, and now as Sean you continue to mislead the uninformed.

RANDY; Keep up the GOOD WORK.

10/07/04 02:51
Patsy 
10/07/04 02:51
Patsy 
The debate

I like to hear both sides of this. We should encourage both of them. This is an open forum I assume.

10/07/04 02:24
Randy H.

not registered

10/07/04 02:24
Randy H.

not registered

Still Blind

My words: "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."

Strike the word "full" from 2nd sentence.

Strike the words "removing only" from 3rd sentence and replace with "severing"

You are quite free to choose to have a surgeon "open" your hand with a knife for any Dups procedure if you like. I'll pass.

Now, you still haven't answered my assertion that the Data, the Personal Testimonies found here and Dr. Eaton's Excitement and Success with NA all seem to strongly indicate that NA and limited fasciotomies are *significantly different* procedures, in that there outcomes are significantly different. If they were not, we'd have a lot more limited fasciotomies being dome. We don't. That is really all I'm trying to show. The "LA Doctor" is just as *blind* to these emerging facts as when you entered this thread. Hopefully now, fewer of our guests here are not.



10/07/04 02:21
Sean 
10/07/04 02:21
Sean 
Fasciotomy

1) NA is a fasciotomy.
2) There is no argument from me. If a person prefers NA instead of a fasciotomy with a blade, that is fine. If a person prefers NA instead of a limited fasciectomy, that is fine. There are many cases when each procedure is preferable instead of the other. Why do you think NA practitioners request a picture of the hand/fingers to determine if a person is a candidate for NA. They realize that there are many occasions where NA is not suitable. If surgeons could pick and choose only the easy or simple candidates it would be much easier for them. Unfortunately, if your are a surgeon, they have to take the most difficult cases as well as the easy cases. They can't say, "we'll only do your hand if the cord is very well pronounced". Or if it is a very difficult condition that, "we can't do the surgery, you will have to see an NA practitioner".
3) There is room for all of the procedures and it is shear stupidity to "badmouth" any of them. We are fortunate to have the choices.
4) And then you might find this hard to believe, but there are some who might prefer a limited fasciectomy just because the recurrence is less likely to appear than with NA. Who is to say whether that decision is right or wrong. It is that person's decision.

10/07/04 02:33
Sean 
10/07/04 02:33
Sean 
Fasciotomy

To answer your question. Your assertion that "NA and limited fasciotomies are *significantly different* procedures, in that there outcomes are significantly different. If they were not, we'd have a lot more limited fasciotomies being dome. We don't."

I can't answer that question, show me the data. My guess would be that there are many more fasciotomies done with a blade rather than a needle. And again, I'm not making a judgement as to which is the best procedure, because I don't know. All I know is from my own experience which was a limited fasciectomy which could not have gone any better, 85 degrees to zero degrees contracture with very little pain, no residual scarring and so far no recurrence.

10/07/04 02:06
jim h

not registered

10/07/04 02:06
jim h

not registered

Im the originator and got a reply from Dr eaton

This is actually a very informative exchange and I wish it could have taken place years ago, before I had my 2 surgeries.

The first one was a full fasciectomy - 3 large incisions - for a classic palm cord extending to the 4th and 5th fingers. Recovery was brutal and a nerve was damaged. If I'd known about NA then, I would absolutely have tried it. It's certainly no more 'dangerous' overall than surgery. First of all, the big risk with surgery is infection, and I've been told the hand is particulary prone to infection, which is why you have to soak and clean the incisions several times a day.

The second surgery was for 2 PIP joints with a lot of adhesion and I doubt NA could have made much of an impact, however, I would certainly have sent photos to Dr. Eaton had he been doing NA at that time.

Dupuytren's is a disease that takes many forms. Let's at least credit hand surgeons with one source of knowledge that nobody else has - they've seen the insides of hands with Dupuytren's.

10/08/04 02:57
howard

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10/08/04 02:57
howard

not registered

Im the originator and got a reply from Dr eaton

Im the originator and got a reply from Dr eaton, I did not give my doctors name in LA (not sure but thought I could be sued) Dr Eaton Replies as follows: "This is standard teaching and what I would have said before I had seen needle aponeurotomy. Recurrence rate is probably higher with NA, but the benefit is quicker recovery. I routinely perform NA now on hands that I would have labelled 'absolutely impossible' in the past. I disagree with the risk of nerve injury, which is clearly less with NA than with traditional surgery. I hope this helps clarify the difference in opinions."

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