An alternative to be considered in the treatment of Dupuytren's Contracture is a procedure invented and developed over thirty years ago by Dr Jean Luc Lermusiaux in Paris, at the Lariboisieres Hospital, where he is Consultant Rheumatologist.

Sadly UK hand surgeons, in the main, have failed to adopt the procedure, preferring the far more drastic invasive surgery, which involves general anaethesia, extensive scarring, and loss of the full use of the involved hand for a considerable time following the surgery, and night splinting of the hand for some weeks following surgery.

The aponeurotomy procedure is available on the Continent, and in the USA, to a lesser extent. A google search for Dupuytren/Lermusiaux/Badois, will take you to contact details for the leading French team of doctors who carry out aponeurotomies, as a matter of routine. Dr Lermusiaux's clinic is in Gagny, a few miles north east of Paris.

Having undergone the procedure myself on two affected fingers, one on each hand, I have had full use restored from the moment the local anaesthetic wore off. The procedure involves insertion of a needle into the affected area, through which a local anaesthetic is injected.
When numbness is achieved, the doctor uses the point of the needle as a miniature scalpel, through the initial entry point, severing the constricting bands, in a matter of minutes, finally straightening the finger, to snap the final portion of the band remaining. The procedure requires no stitches, the full use of the hand and fingers returns as soon as the anaesthetic wears off, and there was no post-operative pain. I carried my luggage back onto the plane home, the afternoon of the procedure, and was playing the piano that evening, being able to stretch a full octave for the first time in over ten years.

There is noone who has had the conventional invasive surgery on offer in the UK, who would be in a position to return to using his hands as quickly, as painlessly, and without extensive scarring, or so inexpensively.

It has been fourteen months since the apo-neurotomy; The best medical decision I ever made, was not to submit to the conventional invasive surgery in the UK, and to trust my instincts that Dr Lermusiaux knew exactly what he was doing. He carried out the procedure with an expertise and modesty, and at a price which made the EasyJet flight to Paris from London the most expensive part of the expedition!

I cannot recommend highly enough that anyone suffering from Dupuytrens Contracture considers the aponeurotomy alternative to the conventional surgery on offer in the UK.

There are some pix of the affected hands pre- and post-, which demonstrate that full use is restored, and there is none of the z-plasty stitching and scars which are such a characteristic of the conventional solution offered in the UK.

Much of the caution expressed amongst British surgeons seems to stem from tales of damage caused with the procedure, long ago. I admit readily that I may have been very fortunate indeed to have had the procedure carried out by the man who developed it in France about thirty-five years ago, and who has been carrying out about ten a day probably, ever since!

But the relevant issue for the UK to examine is the "recent" track record of aponeurotomies in sorting Dupuytrens. France clearly has a huge advantage in terms of case studies to rely upon, as it seems to be scarcely ever carried out in the UK, despite NICE approval. Lermusiaux is the first to admit that Dupuytrens does recur. However in their experience, it does not recur any more frequently with his procedure than the more drastic fasciectomies popular in the UK. It is certainly not something I would want someone to be trying out on me, who had not received adequate training and practice, but I was struck by his comment to me that he was confident that for the simpler palmar involvements with a single clearly defined cord, there was no reason why someone should not be competent to cope with them after a week of hands-on experience and guidance at Lariboisieres. He didn't class it as a surgical procedure himself, claiming he was "only a consultant rheumatologist", but I suppose that may be semantics. But the point he was making was that they train physicians how to carry it out in their own surgeries in France - it was not something I went to a hospital to have done. I have seen enough post-fasicectomy Dupuytrens patients, a few years post-op, whose subsequent scarring and redevelopment of the disease strongly discouraged me from that route. Lermusiaux made the point that although the fibrous tissue remains, albeit sectioned, in his procedure, the potential for scarring is a great deal less, and on recurrence (50% at five years), the same procedure is simply repeated. In the case of my hands there is no evidence to show anything at all has been done to them in terms of entry points - It is only that my fingers are now straight that allays my wife's suspicions of why I felt it necessary to spend an evening in Paris! With fasciectomies you could be looking possibly at skin grafts and so on, a second/third time round, or worse yet, finger amputation! When I quizzed him on nerve damage with aponeurotomies, he referred me to the research findings in France, which demonstrated lower rates than with fasciectomies. But he did mention that if the contracture was primarily digital rather than palmar, it was more complex, & there was a higher risk if the party carrying out the procedure was insufficiently experienced. The NHS "Wait until it is more than 30 degrees out of kilter" before operating, may have its origins in McGrouther and Marshall's Diseases of the Hand, but my personal suspicion is it may also have something to do with managing scarce resources, and it seems to me that aponeurotomies would offer UK Dupuytrens patients, or at least some of them, a swifter, and more simple avenue of release, whilst simultaneously freeing up hand surgeons' waiting lists for more urgent cases.

Where minimally invasive forms of surgery are available, and could free up surgeons for more important cases they need to be encouraged. If your own genes ever cause you to be struck down with this particular affliction, you will not be surprised that I would strongly recommend a flight to Paris!