Our presentation to the Hand Society (ASSH) in Washington, DC on 9/8 went very well. Dr. Seegenschmiedt, from Germany, presented his study on the use of radiation therapy to reduce nodules and prevent the progression of Dupuytren's.
Dr. Hurst spoke about Collagenase, which looks good, but may still be years away from release. I was surprised that only about 200 patients have been treated so far.
Drs. Eaton, Zidel, Denkler and I (Pess) spoke about NA and it's advantages. The talks were well received and I think many of the members' interest were stimulated. There were many good questions.
However, I would not get too excited yet. Don't expect your local hand doc to be doing this right away or even be interested in trying. We need to present conclusive data first and that is what we are working on. It will be the first prospective study on NA in the USA. Only then can we hope to really convince the doubters about the results.
On a personal note, I have been thrilled with the success of NA. I have now treated over 500 hands and perform NA almost exclusively as my preferred treatment for DC.
Sincerely, Gary Pess, MD 732-542-4477 ext. 206 http://centraljerseyhand.com firstname.lastname@example.org
The Washington DC ASSH meeting had about 300-350 doctors interested in updates on lesser alternatives to surgery in Dupuytren's. It is not official policy of the ASSH, and the presentation was a panel, not a paper.
Dr. Seegenschmiedt presented nice work on his use of X-Ray therapy to reduce nodules and lessen progression of Dupuytren's. He was excited to present to hand surgeons.
Collagenase is still years away, but it looks exciting and promising. We all are awaiting its arrival. I published my slide text on my web page with slight editing for the internet and to make it more readable than slides that would have images:
Surgery has major complications as shown by my review of 50 years of papers on surgery for Dupuytren's and over 6,000 published surgeries in peer reviewed medical journals.
NA has many fewer complications as also shown in published peer reviewed journals. Seeing the tissue and the nerves at surgery does not make the complication rate less over the "blind" NA procedure. NA has a higher recurrence rate, but a much faster recovery with fewer complications. Repeated NA procedures will cause complications to be additive over a single surgery. However, long term improvement may occur after a single NA.
My opinion is that NA should be the first step. Then NA may be repeated. If after one or two NA procedures, there is frequent recurrence, then one may proceed to open surgeries. Good luck with your choices! There is no one approach to Dupuytren's and we all await the release of collagenase by Biospecifics.
Keith Denkler, M.D. Larkspur, CA
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