Should I have a third Needle Aponeurotomy surgery for my Dupuytrens?

Dr. Herazy,

I have dupuytren contracture in my little finger on my left hand and have had needle aponeurotomy done on it twice.   It is aggressive and I was considering the procedure a third time  and just heard about you.  I’d like to try an aggressive treatment with you instead–have I missed an opportunity to improve my situation because of the needle aponeurotomy sessions (because of  scar tissue,etc)?

I’d like to speak to you about it if possible – I have a third needle aponeurotomy session scheduled two months from now (28 Nov) that I’d like to cancel…the contracture comes back quickly and the finger is a bit thicker.  Any advice??

Thank you in advance for your attention to this,

Scott Riviere

 

Greetings Scott,

Needle aponeurotomy is well known for rapid recurrence of Dupuytren contracture.   Although you did not say how quickly your Dupuytren’s returned after your first and second hand surgery, it is not uncommon for the palm lumps and cords to come back back in two years or so, with the rate of recurrence increasing after each NA surgery. 

The increased thickness of your finger could be due to chronic swelling or edema that is the result of scar tissue that prevents normal drainage of blood and lymph fluid out of the hand.   Or, it could be directly due to scar formation from the internal cutting that is part of the NA technique.  Either way, this is a frequent side effect of hand surgery for Dupuytrens.   

The rapid recurrence of Dupuytren contracture after needle aponeurotomy and scar tissue build-up are two of the nasty consequences of this kind of hand surgery simply because, as you have found out, the technique not only solves nothing but it can leave you worse off than before it was done.      

My advice is that you be extremely cautious about undergoing a third needle aponeurotomy.   What has your surgeon told you about the possible outcomes of a third NA if the first and second did not help you and resulted in undesirable side-effects?    Did he/she say why you should expect the results of this third surgery to be any different than the first two?   Did he/she warn you about further acceleration of the rate of recurrence with each succeeding NA procedure?   Did he/she warn you about the increasing risk of possible injury to blood vessels, nerves and tendons that occurs with each succeeding hand surgery?    Did he/she warn you that these hand surgeries would eventually have to stop?   Did he/she speculate what the eventual condition of your hand might be if you had 4-5-6 surgeries, and how useful, painful, numb or flexible your hand might be?   did he/she discuss with you what your options might be when you can no longer have additional NA surgeries?

Please be even more cautious if you are told that this next surgery will be more extensive to reverse or clean up the problem scar tissue that resulted from the others.  I have never heard of any  “clean-up surgery’ that goes well for the patient; usually it goes in the opposite direction and creates more problems.   Mind you, I am not saying to not have the surgery and I am not saying to not listen to your doctor, I am just saying to use the highest level of caution and prudence when you make this decision.

Time will tell how effective an aggressive Alternative Medicine treatment plan might be to help your current condition.  I have worked many times with people who have a history of past hand surgery who find their problem worse than when they started; some make great improvement, while most make at least a small to moderate amount of change; very few do not at least make some small level of improvement.   I cannot answer you directly about how effective natural therapy might be for you, but considering your options I suggest you consider undergoing an intense round of therapy for 2-3 months to determine how much change your body can make.   You will only know for sure when you give it your best effort.   

I would be pleased to speak to you about your Alternative Medicine treatment options.   The important thing is to not make matters worse at this point.   Simply call me at 847-670-8800.     TRH

 

 

 

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