Compare

**Compare NA to Xiaflex (Collagenase)**
Needle Aponeurotomy and Xiaflex collagenase treatment accomplish the same goal: cut the cord without making big cuts in the skin. With Needle Aponeurotomy, the cords are cut with the tip of a needle at multiple locations; with Xiaflex, one section of one cord is dissolved after being injected with the medicine. NA is mechanical, Xiaflex chemical. An analogy of the difference is a clogged drain: if NA is like using a plumber's snake (immediate result), Xiaflex is like using drain cleaner (put it in and the result follows a short time later). Although both techniques have been described as "nonsurgical", they are each minimally invasive fasciotomy procedures, one performed with a miniature knife, one with a chemical knife. A comparison is below.
	NA	Xiaflex
Learning curve for the doctor	Longer	Shorter
Cost?	Less	More
Not recommended if... (Contraindications)	After some hand surgeries Open wound on hand Current hand infection	After some hand surgeries Open wound on hand Current hand infection Lymph node surgery or lymphedema Pregnant, possibly pregnant, or breast feeding Prior allergic reaction to Xiaflex
What can be accomplished with one treatment of one hand?	All areas of multiple cords, multiple joints, multiple fingers	One section of one cord
How many treatments are needed per cord / joint?	One	Usually one. Some patients need a second injection
Both hands treated?	On consecutive days	On consecutive months
How many appointments are needed for a treatment?	One office visit for Evaluation and Treatment	Two or three visits: Evaluation; Injection; Manipulation.
How long does the actual treatment take?	10 - 20 minutes per finger	Less than a minute
How is the hand bandaged the night of treatment?	Remove bandaids; OK to wash or shower	Change bandages
What happens the day after treatment?	Begin hand exercises: Begin night time splinting (some patients)	Return to office for finger manipulation, possibly with anesthetic injection; Begin night time splinting (some patients)
Common issues (experienced by at least one out of four patients) during the first week after treatment	Mild hand bruising Hand pain or tenderness	Mild hand bruising Hand swelling Hand pain or tenderness Itching Breaks in the skin
Possible complications	Tendon Cut Nerve Injury Infection	Tendon rupture Nerve Injury Infection Ligament Injury Allergic Reaction
Effectiveness / Recurrence	Probably the same

**Compare Either NA or Xiaflex to Open Surgery (Fasciectomy)**
Because they are less invasive, NA or Xiaflex can be performed at an earlier stage than surgery. Recurrence is a problem with any treatment, but is more likely following NA or Xiaflex than surgery. Severe contractures of the proximal interphalangeal joint (the knuckle in the middle of the finger) are more reliably treated with surgery than with NA or Xiaflex. Repeat treatment after NA or Xiaflex is usually straightforward. Repeat surgery after surgery is not. Complications from open surgery are much more common than with NA or Xiaflex. The real difference between NA or Xiaflex and open surgery is the *recovery time*. With NA, it is possible to have both hands treated over a few days, and in most cases resume full normal activities within a week or two - compared to an average four to six month recovery for both hands following open releases. More information is available on the NA-FAQ page.

**Which is better, NA or Xiaflex?**
Unknown. This question needs further research. Depending on a variety of factors, some patients may do better with one or the other. Both techniques have advantages over traditional open surgery. Neither is a cure for Dupuytren's - recurrence is common with both. The choice is up to the individual patient and their treating physician, and the decision depends on the level of comfort of each, the individual pattern of joint involvement, cord geometry, skin involvement and the latest available information. This and other questions about Dupuytren's can only be answered through additional research. You can help the effort to find better treatment options for Dupuytren's by supporting the Dupuytren Foundation.

**How many hands has Dr. Eaton treated with NA?**
Dr. Eaton performs an average of one thousand NA procedures per year and has been doing this since introducing NA to the United States in 2003.

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