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.)

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."

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

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.

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.