Just had two procedures done simultaneously, a dermofaciectomy with skin graft, (DF/SG), in webbing between right thumb and index finger, and a NA on a prominent band and large affiliated nodule on the same thumb. I was glad to get a gander at the NA technique… here is what I saw… The large (pea sized) nodule rested at the palmar base of the thumb, and fibers radiated from that nodule in all directions. The largest of these fibers had developed into a thick cord running up the (lateral) side of the thumb to a smaller nodule at the thumb’s DIP. The surgeon first needle-cut the inch long lateral cord in three places. He then needle-cut the fibers radiating from the large nodule, by going around and under the nodule removing the nodule’s tethering. The NA took 5 minutes, the DF/SG took 1.5 hours.

No pain, the axial block for the DF/SG took care of that. Sadly, I am not able to see the final work o’ the needle as the grafting bandages cover the area.

This NA has provided a fourth procedure for my procedure list, (now F, DF/SG, X, NA,) and I need only to experience RT to join the prestigious 5 procedure club. Better plan a trip to Hamburg soon for my induction "ceremony".

Good Question. The two areas are about 1 inch apart, one in the middle of the webbing and the other on the lateral side of the thumb. I asked for the graft on the first site to release the thumb to index contracture. The nodule and cord at the second site had not yet caused a contracture. During the pre-op I asked the doctor if he would like to try a NA on the cord... he agreed. I did not ask for a faciectomy or a DF/SG on the second site. ( All my previous faciectomies have rapidly led to recurrance, so I only ask for grafts.) I chose not to ask for double graft and try NA for a change. We shall see if the NA leds to recurrance. I hope NA will become an option for me.