Collagenase (Xiaflex™) injections for Dupuytren's Disease

Xiaflex - Information Sheet

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How is a collagenase injection used to treat Dupuytren’s Disease?

Dupuytren’s Disease is a thickening of the tissue of your palm and fingers. It causes the formation of lumps or bands of collagen (also called cords) which cause your fingers to become permanently bent inwards.

You don’t have to have treatment for Dupuytren’s Disease, but when it causes your fingers to bend significantly, or it starts limiting the function of your hand and fingers, it may be time to think about treatment.

Read more about Dupuytren’s Disease.

A collagenase injection is a non-invasive treatment option for Dupuytren’s disease. I use Xiaflex for these injections, which consists of collagenase enzymes. As part of this non-surgical treatment, I inject Xiaflex into the affected area of your hand to break down the Dupuytren’s cord.

 

Can I be treated with Xiaflex™?

While Xiaflex is a safe treatment option for many patients, it is not recommended for the following groups:

  • People with blood clotting disorders
  • People on anti-coagulants (aspirin is fine)
  • Pregnant / breast-feeding women
  • Collagenase within 30 days
  • Allergy to collagenase
  • Tetracycline use

During your first visit, I will ask you about your medical history and examine your hands to determine if Xiaflex could be a suitable treatment for you.

 

What does Xiaflex™ treatment involve?

Xiaflex treatment requires two visits on consecutive days.

During the first visit, you will receive the Xiaflex injection into the Dupuytren’s cord. When you return for your second visit, I will straighten your finger. Up to two cords can be treated at one time.

 

Visit 1: Injection of enzyme – Mercy Hospital, Dunedin

The injection is administered at Mercy Hospital, Dunedin. You will spend about an hour at Mercy Hospital, during which time you will briefly be admitted, receive the injection and spend half an hour being monitored for any adverse effects (these are very rare) by the nursing staff.

To inject the enzyme, I use a very fine needle. Local anaesthetic is not recommended, but the injection will be over very quickly.
Please let me or the nursing staff know if you experience any of the following:

  • Redness, rash, swelling, difficulty breathing
  • Signs of infections such as fever, chills
  • Numbness or tingling in the hand

After the injection, your hand will be wrapped in a loose bandage. Please keep the bandage dry. I ask you not to perform strenuous activities with your hand. Do not massage the area or bend and straighten the hand un-necessarily. Please elevate your hand when possible.

Swelling and bruising of the hand, sometimes extending up the arm is common after the injection. If you experience discomfort, regular simple pain relief such as paracetamol or nurofen will help.

 

Visit 2: Manipulation (finger-straightening procedure) – Fernbrae House, Dunedin

The next day we meet at Fernbrae House for the manipulation of the cord. You will be given local anaesthetic to numb the area. I will then try to manipulate (break) the cord, and hopefully your finger will straighten. Occasionally the skin overlying the cord tears; this will heal with simple dressings. This appointment takes 20-30 minutes; while the manipulation is very quick, I like to wait for the anaesthetic to have good effect.

Following the procedure, you will have an appointment with the hand therapists who will provide you with a splint to wear at night for 3 months.

You cannot drive directly after the procedure. If you feel comfortable and safe to drive a motor vehicle after 2-3 days, you’re welcome to do so. You can gradually return to normal activities as comfort allows.

 

Follow-up visit

Follow-up consultations are arranged as required. If you have any queries then please contact me and I will contact you as soon as I am able.

 

What are the side effects of Xiaflex™?

Mild to moderate side effects are common and usually resolve within two weeks.

Common side effects (about 10% chance of happening):

  • Bleeding, pain, swelling, tenderness and bruising at the injection site on your hand
  • Itching
  • Discomfort
  • Swelling of your hand or arm
  • Enlarged lymph nodes near your elbow or armpit
  • Skin tear at the site of the cord after the finger-straightening procedure

Rare side effects (very slim chance):

  • Damage to your nerve or blood vessels
  • Damage to your tendons or pulleys
  • Allergies
  • Complex regional pain syndrome (a painful stiff and swollen hand)

 

Does Xiaflex™ always work?

I’m afraid a Xiaflex injection does not always work. Sometimes, more than one injection is required to break down the Dupuytren’s cord in your hand. Sometimes, you may decide to wait or proceed with surgery.

 

Will the Dupuytren’s Disease return?

Unfortunately, there is no cure for Dupuytren’s Disease. The rate of recurrence after Xiaflex is still being investigated, but it is likely to be about 40% recurrence by 10 years. Xiaflex is a new treatment and so long term studies about Xiaflex are still being performed. However it would seem that Xiaflex treatment could be repeated and that surgery, if desired at a later stage, should also be possible.