Peter G. Fitzgibbons, MD
Hand & Upper Extremity Surgeon
Dupuytren's contracture is thickening of the fibrous tissue layer under the skin of palms, fingers, and hands which leads to curving of the finger. It is caused due to the excessive production of collagen which gets deposited under the skin. Hereditary factors, excessive alcohol consumption, diabetes, seizures, and increased age may increase the risk of developing the condition.
The most commonly observed symptoms of Dupuytren's contracture are lumps or nodules in the palm, difficulty in straightening the finger, and contracture of the nodules which forms tough bands under the skin.
Treatment with Xiaflex
Dupuytren’s contracture can be treated by both non-surgical and surgical methods. The new and effective treatment for Dupuytren’s contracture is treatment with Xiaflex (collagenase Clostridium histolyticum). Xiaflex is comprised of two collagen enzymes that have hydrolytic activity and breaks the collagen that causes contracture.
Xiaflex, 0.58 mg is directly injected into the palpable Dupuytren’s cord that affects the proximal interphalangeal (PIP) joint or metacarpophalangeal (MP) joint. After 24 hours of injection, your physician will perform finger extension procedure to bring about cord disruption.
If the contracture persists after the Xiaflex injection, the finger extensions and subsequent injections are administered once in four weeks and maximum of three times per cord. Injection is given to one cord at a time. If an individual has contracture in other cords, then the injection is given in sequential order.
The common side effects of Xiaflex include fluid builds up in the tissue, lymph nodes in the elbow or underarm swells up, bleeding, pain and tenderness in the injected area, and itching. However, these risks are mild and moderate and can be resolved.
Your surgeon will ensure that Xiaflex is not injected into surrounding healthy collagen- containing structure such as the tendon and ligament, as it may result in the permanent damage of the tendon or ligament. However, this can be treated by surgery to fix the damaged structure.
Please inform your physician if you are taking any prescribed medicines or non-prescribed medicines. Also, individuals with anti-coagulants disorders who are taking aspirin, Coumadin®, Plavix®, or Effient® should discussed physician before initiating Xiaflex.