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NA success rate
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04/19/2008 15:47
Dyingbreed45 
04/19/2008 15:47
Dyingbreed45 

Re: NA success rate

I would love to see results good or bad. That would be excellent yes it isn't a controlled study like most studies are done but it is realistic since real patients with NA report what has or has not happened since the procedure.

There are many variables as far as how bad the contracture, if other procedures have been done before the NA etc. Any knowledge of results is better than nothing. Hope to see some results. Thank you for all the support.


Got Dups the hard way,

Dyingbreed45

04/19/2008 17:44
GUEST

not registered

04/19/2008 17:44
GUEST

not registered

Re: NA success rate

48 y.o. male, 10 years ago i had traditional surgery on left hand. good for about 2 years till dup showing return, another 7 years till it got so bad i tried NA. one year ago this month, i had NA done on both hands(6 fingers, both palms), good for less then a year till dup returned to same level or worse. very dissappointed with the NA. i was so excited after the NA to see all my fingers and both palms straight, but even wearing a splint didnt stop the fast return. i hate DUP!!!

04/20/2008 05:32
wach 

Administrator

04/20/2008 05:32
wach 

Administrator

Re: NA success rate

Hi "guest", I can understand why you hate Dupuytren's ... how long did you wear the night splint after NA? All the time or just a few weeks? My hope is that wearing a night splint avoids recurrence.

Wolfgang

Quote:



48 y.o. male, 10 years ago i had traditional surgery on left hand. good for about 2 years till dup showing return, another 7 years till it got so bad i tried NA. one year ago this month, i had NA done on both hands(6 fingers, both palms), good for less then a year till dup returned to same level or worse. very dissappointed with the NA. i was so excited after the NA to see all my fingers and both palms straight, but even wearing a splint didnt stop the fast return. i hate DUP!!!


04/20/2008 05:39
wach 

Administrator

04/20/2008 05:39
wach 

Administrator

Re: NA success rate

There are some published statistics. Foucher & Co picked 100 NA patients at random and tracked the longer term results (that paper is cited at the end of web page http://www.dupuytren-online.info/NA_side_effects.html). They find "postoperative gain was prominent at metacarpophalangeal joint level (this is the base joint and they find 79%) ... In the group assessed at 3.2 years follow up, the recurrence rate was 58%".

Wolfgang

Quote:



What is the success rate of NA? How long before DC starts to come back? I am sure that it differs for each individual but what are the statistics? From what I have read here it seems to be all pro. What are the cons?

Got Dups the hard way,

Dyingbreed45



04/21/2008 02:37
Dyingbreed45 
04/21/2008 02:37
Dyingbreed45 

Re: NA success rate

Thank you for the link wolfgang.

What happens is not by choice but by selection.

No one chose to have DC.

Nor would anyone want to wish it on anyone.

But DC can't be ignored nor the reality of cases that have "negative" effedts.



Got Dups the hard way,

Dyingbreed45

04/24/2008 15:08
Dave 
04/24/2008 15:08
Dave 
Re: NA success rate

I had NA with Dr. Pess almost a year ago to the day. My little finger was at 90 degress to my others. The NA reduced that to 25. Physical therapy got that as low as 18. One year later it around 25. But it's a battle. I wear a brace for a few hours a day and every night use moist heat packs and force to stretch it according to therapist's instructions. I'm holding even now but I truly believe that if I let up the treatment, it would bend back.

Dave

04/24/2008 15:11
Dave 
04/24/2008 15:11
Dave 
Re: NA success rate

Oh, and I should add, that I had open surgery on that digit before my NA and the reoccurrence happened in about three years. I figure if I can do battle like this for another two year, I break even but come out way ahead because of the convenience of NA.


Dave

04/26/2008 02:38
lumpy 
04/26/2008 02:38
lumpy 
Re: NA success rate

Had NA five weeks ago. According to Dr. pess, my ring finger was at 17 degrees, so I had the procedure done. the condition had beeen monitored for over two years i have full movement of the finger, and the hand was functional in one day. the cord is minimally visible. there is some occasional discomfort. I can play golf without problems (the club grip lays across the area affected) do pushups. and otherwise function at full capacity

04/26/2008 22:32
kdenkler 
04/26/2008 22:32
kdenkler 
Re: NA success rate

Controlled study of NA:

J Hand Surg [Am]. 2006 May-Jun;31(5):717-25.
A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study.
van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM.

Department of Plastic, Reconstructive, and Hand Surgery, Isala Clinics, Zwolle, the Netherlands.

PURPOSE: The demand for percutaneous needle fasciotomy (PNF) as treatment for Dupuytren's disease is increasing because of its limited invasiveness, good outcome, limited number of complications, quick recovery, and overall patient satisfaction. This randomized controlled trial was designed to test whether these short-term expectations are sound by comparing this treatment with limited fasciectomy (LF) with regard to these aspects. METHODS: We treated 166 rays: 88 by PNF and 78 by LF. Total passive extension deficit (TPED) improvement at 1 week and at 6 weeks were the primary outcome parameters; patient satisfaction, hand-function recovery, and complication rate were secondary outcome parameters. We used the Disabilities of the Arm, Shoulder, and Hand questionnaire to measure disabilities of the upper extremity before and after treatment and all adverse effects and complications were recorded. RESULTS: Overall TPED improvement was best at 6 weeks. In the PNF group TPED improved by 63% versus 79% in the LF group; this difference was statistically significant. Results at the proximal interphalangeal joint were worse than those at the metacarpophalangeal and distal interphalangeal joints for both the PNF and LF groups. The rays classified before surgery as Tubiana stages I and II showed no difference between these treatments, but for rays higher than stage II LF clearly was superior to PNF as a treatment modality. The rate of major complications in the LF group was 5% versus 0% in the PNF group. Patient satisfaction was almost equal but direct hand function after treatment was considered better in the PNF group, as was the degree of discomfort that patients experienced. This was underscored by the Disabilities of the Arm, Shoulder, and Hand scores in the PNF group, which were significantly lower than those in the LF group at all time points measured. CONCLUSIONS: In the short term and in cases with a TPED of 90 degrees or less PNF is a good treatment alternative to LF for treatment of Dupuytren's disease. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level I.

04/28/2008 10:27
Ellen MG

not registered

04/28/2008 10:27
Ellen MG

not registered

Re: NA success rate

Thank you Dr. Denkler for the text of the 2006 Zwolle study. I guess this would still mean that you would endorse NA as an "entry" choice before open hand surgery even though the satisfaction with open surgery was higher and statistically significant? When would you think that open surgery would be a first choice or at what stage would you advise someone to go for open surgery?

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