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Advice/recommendations please - I live in Spain - Alicante province.
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08/13/18 18:13
Guitareth 
08/13/18 18:13
Guitareth 
Advice/recommendations please - I live in Spain - Alicante province.

I am a male aged 62 years who needs advice re surgery to fix my problems with Dupuytren’s on my RIGHT hand, third (ring) and fourth (pinkie) fingers. Some background first. I am from Scotland and was first diagnosed with Dupuytren’s many many years ago when living in Scotland. However, since 2009 I have lived in Spain (Costa Blanca, Alicante region – near Dénia) and first had surgery for Dupuytren’s on my LEFT hand fourth (pinkie finger) at a private hospital in Benidorm in March 2015. That surgery was reasonably successful (but not perfect – I still could not fully straighten my finger) and I have since had a very annoying problem with dry/scaly skin on that finger. As the latter is a separate problem, I have posted a separate topic here about that particular issue.

The Dupuytren’s on my RIGHT hand, THIRD and FOURTH fingers has now got very bad (see following/attached photos) and I am looking for recommendations or advice for a surgeon I should go to for surgery to fix them.







I am very reluctant to go to the private surgeon or hospital I used in Spain for my previous surgery (IMED Benidorm) as, while it was good that it was covered under my private health insurance policy in Spain, I have never been happy with the outcome of that surgery. I would obviously prefer to go to a surgeon in the Valencia communidad in Spain, but am willing to consider someone elsewhere in Spain, or even in France if they are strongly recommended. For my previous surgery on my left hand this was a fasciectomy. I do not know whether it was the type classed as “Open” or “partial” but I can confirm it was done under a general anaesthetic with an overnight stay in hospital.

I would prefer to have my current right hand problems fixed using NA (needle aponeurotomy) if at all possible, and would appreciate if anyone can advise if that is likely to be a suitable option after reviewing my photos. Note all photos show my fingers as straight or flat as I can make them at present.


I look forward to advice/recommendations. Many thanks in advance.

Gareth

Edited 08/13/18 20:40

Attachment
Right_palm_from_above.jpg Right_palm_from_above.jpg (3x)

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Right_back_flat.jpg Right_back_flat.jpg (2x)

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Right_flat_palm_down_B.jpg Right_flat_palm_down_B.jpg (3x)

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08/13/18 19:20
wach 

Administrator

08/13/18 19:20
wach 

Administrator

Re: Advice/recommendations please - I live in Spain - Alicante province.

Hi Gareth,

for me, a patient and layman, your fingers look like being suitable for NA. Don't expect your pinkie to become fully straight again (mine didn't), the middle (PIP) joint is the worst of all to treat, with NA and with surgery. Also, after NA, it might be worth while wearing a night splint for 6 - 12 months.

Finding a doctor for NA in Spain might be difficult but you can find many in France http://f.badois-dupuytren.assoc.pagespro...tml/gblist.html . I can't say who is the best but there is a lot of experience with this technique in France.

Wolfgang
PS: we usually Count fingers differently, i.e. include the thumb. Your pinkie would be 5th.

08/14/18 17:00
Guitareth 
08/14/18 17:00
Guitareth 
Re: Advice/recommendations please - I live in Spain - Alicante province.

wach:
Hi Gareth,

for me, a patient and layman, your fingers look like being suitable for NA. Don't expect your pinkie to become fully straight again (mine didn't), the middle (PIP) joint is the worst of all to treat, with NA and with surgery. Also, after NA, it might be worth while wearing a night splint for 6 - 12 months.

Finding a doctor for NA in Spain might be difficult but you can find many in France http://f.badois-dupuytren.assoc.pagespro...tml/gblist.html . I can't say who is the best but there is a lot of experience with this technique in France.

Wolfgang
PS: we usually Count fingers differently, i.e. include the thumb. Your pinkie would be 5th.

Many thanks for that. OK, of the ones on the French list, who is most commonly recommended? Also, if anyone has used any of them I'd appreciate idea of costs for surgery.

08/14/18 20:23
spanishbuddha 

Administrator

08/14/18 20:23
spanishbuddha 

Administrator

Re: Advice/recommendations please - I live in Spain - Alicante province.

Guitareth:
wach:
Hi Gareth,

for me, a patient and layman, your fingers look like being suitable for NA. Don't expect your pinkie to become fully straight again (mine didn't), the middle (PIP) joint is the worst of all to treat, with NA and with surgery. Also, after NA, it might be worth while wearing a night splint for 6 - 12 months.

Finding a doctor for NA in Spain might be difficult but you can find many in France http://f.badois-dupuytren.assoc.pagespro...tml/gblist.html . I can't say who is the best but there is a lot of experience with this technique in France.

Wolfgang
PS: we usually Count fingers differently, i.e. include the thumb. Your pinkie would be 5th.

Many thanks for that. OK, of the ones on the French list, who is most commonly recommended? Also, if anyone has used any of them I'd appreciate idea of costs for surgery.
Dr Manet Chopin comes up quite a bit for NA. See this thread for further info https://www.dupuytren-online.info/Forum_...25442578.html#5

09/04/18 14:56
Guitareth 
09/04/18 14:56
Guitareth 
Re: Advice/recommendations please - I live in Spain - Alicante province.

Just to update on my own case. After failing to find anyone in Spain who offered NA (and having decided I DEFINITELY did not want to go down the surgery route again) I decided "let's go directly to the experts in this field" so I emailed Dr Marie Pascale Manet Chopin in Paris on 20/08/18 with various photos. After a week went by I was getting a bit concerned about lack of a response, but on 30/08/18 she replied saying it's possible to treat my right hand thumb with NA, and it's also possible to treat my right hand 4th and 5th fingers, but after treatment she said my fingers may not gain complete extension (because my joint is probably fixed in flexion) but "they will be better". She also said it was possible to treat all 3 fingers on my right hand at the same time. After treatment I must not lift heavy things for 3 weeks and must keep it bandaged and dry for 3 days.

She also said she could not treat my LEFT hand little finger by needle aponeurotomy because it is a recurrence after my previous surgery.

I have since confirmed appointment for both fingers and thumb of my right hand to be treated by NA at her clinic in Paris on November 9th. The whole treatment will be completed within an hour. Fee was quoted as 320 euros. I am very happy to have made this decision and look forward to a successful outcome!

I will keep you all posted on this thread to let you know how it goes.

01/30/19 18:32
Guitareth 
01/30/19 18:32
Guitareth 
Re: Advice/recommendations please - I live in Spain - Alicante province.

In my last post on this thread I said I would keep you all posted on this thread to let you know how it goes. Apologies for taking so long to do so, but here goes......

I had my appointment with Dr Manet for Needle Aponeurotomy (NA) on 9th November 2018. It was an appointment lasting 1 hour at which she would treat my thumb, 4th and 5th (pinky) finger of my right hand. In summary it went very well indeed and I am delighted with the outcome. Having now experienced surgery to treat Dupuytren’s on one hand, and NA on the other, I can most definitely say that NA is the way to go. I really can’t see any reason why anyone would consider surgery over NA.

Anyway, for anyone who would appreciate greater detail of my own experience, forgive the long post and read on…………

I found Dr Manet to be a very smiley, friendly person who immediately made me feel at ease. I was also relieved to find that her English was very good – as my French is extremely limited! We were therefore able to converse in English fairly easily. She firstly inspected my hands, and measured the angle of bend on my fingers. She confirmed that she would not be able to completely straighten my pinky finger, but it would be straighter, and said that for my 3rd finger and thumb she hoped to return them to almost normal. She also asked me whether there was a family history of the disease which I confirmed, and she said this was very common. After about 5 minutes we moved through to the adjacent treatment room. She got me to wash my right hand and I then reclined on the treatment couch.

Dr Manet laid out her syringes, needles etc. on an adjacent table. With my right hand lying palm upwards she firstly marked where she planned to insert the needles using a pen. Before starting, and several times throughout the procedure she cleaned my hand liberally with iodine. She warned me that the initial injections of the local anaesthetic would be slightly painful. In fact, the injections of the anaesthetic into my 3rd and 4th fingers were relatively painless but the one into the base of my thumb was quite painful. However, within a matter of seconds the local anaesthetic kicked in and during the rest of the procedure I could not feel a thing in my hand.

She then set to work on each finger. I chose to watch the procedure but if you are not comfortable with this you could simply avoid watching. She pushed the needle into the cord at various points and cut them using a to-and-fro movement of the needle perpendicular to the palm. I expressed surprise at the loud clicking noise as she rocked the needle and she explained that the cords which form are very hard, almost bone-like. It became obvious just how hard they were, as she had to change the needles quite frequently as they had become bent! After doing this on various points of my finger she then completed the process with a firm extension of the treated finger to completely snap the cords. I could immediately see how much straighter the finger had become.

We chatted as she worked away and after around 40 minutes she had completed treating both fingers and my thumb. She applied small self-adhesive dressings on each finger and then wrapped a bandage around my hand.

We then went back through to her office where she measured the angle of the fingers again which demonstrated just how successful the procedure had been. As advised pre-op, she highlighted that it had not been possible to completely straighten my pinky finger, but I could see it was definitely much improved, and my third finger and thumb appeared to be good as new! She told me to keep the dressings clean and dry, and after 3 days to remove them completely. For 3 weeks I should also avoid heavy lifting with that hand or any other activities which might put excessive stress on the hand/fingers. She gave me a couple of wooden splints (similar to ice lolly sticks) and advised me that for the next 3 weeks when I go to bed I should insert these inside a cotton glove and wear these to keep my fingers straight while sleeping. She told me there were no other exercises or rehabilitation procedures required.

After just less than 1 hour, and with all three fingers treated, my treatment session was complete. I thanked Dr Manet profusely for the successful outcome, and paid her the agreed fee.

Continued in my next post..............

01/30/19 19:24
Guitareth 
01/30/19 19:24
Guitareth 
Re: Advice/recommendations please - I live in Spain - Alicante province.

I will not quote the exact fee on here, as I understand her fee will vary dependent on the amount of work involved. However, to give a clue (!!) I can say that to treat all 3 fingers I paid less than 400 euros - which I think is amazing value for money.

My hand felt numb for most of the afternoon but there was certainly no pain at all. My wife and I went for a light lunch and spent the rest of the afternoon strolling around Paris enjoying the sights. In fact, on checking the fitness app on my smart watch later that day, I found we’d walked around 15 kms that afternoon! By the evening the anaesthetic had worn off and I could use my hand fairly normally, but avoided using it as much as possible in order to keep the bandage clean.

Here are photos comparing my fingers before and after the NA treatment to my RIGHT hand

Below taken 1 hour BEFORE NA treatment (showing fingers as straight as could make them):



Below taken 8 days AFTER NA treatment (showing fingers as straight as could make them):



Continued in my next post..............

01/30/19 19:29
Guitareth 
01/30/19 19:29
Guitareth 
Re: Advice/recommendations please - I live in Spain - Alicante province.

......
My Conclusions

I have now experienced two different approaches to treating Dupuytren’s Disease:

1. March 2015: Palmar fasciectomy surgery on the little/pinky finger of my LEFT hand at a private hospital in Spain: This involved overnight hospitalisation, surgery under general anaesthetic, and approx. 3 months recovery. As this operation and follow up treatment was covered by my private health insurance I do not know the cost, but suspect it runs into thousands of euros. The finger was improved but is still not completely straight and I have an ongoing problem with dry, flaky and itchy skin/scar tissue.

2. November 2018: Needle aponeurotomy (NA) procedure on two fingers and thumb of my RIGHT hand, as performed by Dr Manet at her Paris clinic: This required a single 1 hour treatment session (Approx 20 mins is typically required to treat each finger by NA), performed under local anaesthetic. The cost for all three fingers was less than 400 euros. My little finger was much improved but is still not completely straight, but my third finger and thumb are pretty much back to normal. Straight after the procedure I was able to use my hand almost completely normally (except for the inconvenience of a bandage which I had to keep dry) but after only 3 days this was removed. For 3 weeks I had to avoid heavy lifting but since then I have been able to use my hand normally.

As you can probably guess, I feel that the Needle aponeurotomy (NA) procedure is by far the best way to proceed if you need treatment for Dupuytren’s Disease and I feel that it’s a great shame that this procedure is not better known, and more broadly practiced throughout the world as an alternative to other available treatments.

There are other experienced practitioners of the NA procedure around the world (as listed on this website) but I can thoroughly recommend an appointment with Dr Manet in Paris, as even allowing for additional costs of travel and accommodation, you will have the peace of mind of know that you are being treated by one of the very top experts in this procedure. People fly from all over the world for treatment by her, and for good reasons. On the day of my own treatment she told me that two of her patients expected that afternoon were coming over from Australia.

If anyone has any further questions don't hesitate to ask.

01/30/19 22:10
spanishbuddha 

Administrator

01/30/19 22:10
spanishbuddha 

Administrator

Re: Advice/recommendations please - I live in Spain - Alicante province.

Thanks for the comprehensive feedback Guitareth!

01/30/19 22:35
Stefan_K. 
01/30/19 22:35
Stefan_K. 

Re: Advice/recommendations please - I live in Spain - Alicante province.

Hi Guitareth. Thanks for the detailed description. I wonder if Dr. Manet has picked up my splinting solution which I described in this forum and to her colleague at Lariboisière hospital who had not told me about splinting when he performed successful NA on my pinky there in 2014.

Has the splinting managed to straighten your pinky further and do you continue to wear the splint glove? Or are you keen on another trip to Paris in a few years? :-)

Stef

[56, Dupuytren diagnosis 2006, RH contracture and PNF/NA 2014, radiotherapy RH 2015, LH 2017 & 2018, night splint glove RH since 2015]

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