Dupuytren’s contracture (also known as Dupuytrens disease) affects the hands and fingers and can make the simplest of activities difficult for sufferers. Here, Spire Washington Hospital’s consultant Mr Jeff Auyeung, who specialises in a hand and wrist surgery, tells us about Xiapex injections, a relatively new and successful treatment for the condition.
What are the symptoms of Dupuytrens contracture and who is likely to get it?
Dupuytren’s disease is a condition that affects palms of the hand, causing the fibrous tissues under the skin to thicken and contract and fingers to bend inwards. It traditionally affects middle aged to elderly Caucasian males but it can affect others too. Sufferers can’t straighten their hand, put it flat on the table, put their gloves on or get their hand into their pocket – lots of things about daily life are difficult. It can be painful in the early stages due to changes in the fibrous tissue collagen composition but the pain tends to subside after that.
What is Xiapex and how is it used?
Xiapex is a mix of two enzymes that are injected into the fibrous cords (the thickened bands of tissue) just under the skin that are causing the problem. The injection has to go into specific ‘safe’ areas to avoid complications and we can only inject to straighten one joint at the time. Patients have to stay for half an hour after the procedure to ensure they haven’t had an allergic reaction. Although no pain relief is given at the time, patients are advised to take paracetamol on their return home if they experience any later discomfort.
The injection is given 24 hours to work in which time the enzymes set to work breaking down the abnormal fibrous tissue, before the patient is asked to come back to the hospital for what is known as ‘manipulation’ under local anaesthetic. We then perform an extension procedure during which we apply pressure to straighten the bent finger out. Occasionally patients will hear a ‘carrot snap’ type noise and all that means is that we have broken down the remaining abnormal tissue, which despite the daunting noise is a very good thing. At the end of this, patients are given a hand splint to wear overnight to maintain the correction for four weeks before they come back for a (hopefully) final check up.
What type of results do you get and is there an alternative to the injection?
We expect to see immediate results and achieve an 80%-100% improvement straight away. If we are not satisfied with the progress made, it is possible to re-inject and re-manipulate up to three times in total.
An alternative treatment method is surgery and this would be done as a day case procedure with the option of general or regional anaesthetic. Depending on the severity of the condition, the operation takes between 45 – 90 minutes and recovery usually takes around a month to six weeks.
How long do the Xiapex injections last?
In terms of longevity it is important to note that Dupuytrens contracture is a genetic condition so the problem can recur any time, whether you choose the injection or surgery.
Who is not suitable for a Xiapex injection and what are the complications?
As with any treatment, not everyone is suitable for a Xiapex injection and there are risks involved. Anyone taking a blood thinning medication called Warfarin or who has had antibiotics in the last fortnight would not be eligible. Pregnant ladies couldn’t be treated this way, nor could anyone allergic to the injection’s ingredients.
In terms of complications, the most common are swelling of the hand, pain and splitting of the skin where it has torn at the manipulation stage (the latter generally heals within 2-3 weeks). It is important to discuss all these with your consultant who will be able to talk you through what to expect and hopefully put your mind at rest if you have further questions.