Dupuytren’s contracture is a hand deformity that is most peculiar. No one knows what causes it or why it develops exactly. Dupuytren’s contracture affects the connective tissue under the skin of the palm of your hand, forming knots of tissue under the skin. It develops slowly and insidiously over years, eventually forming a thick cord that pulls one or more of your fingers into a bent position. It usually affects the ring finger and pinky and occurs most commonly in older men of Northern European descent. Once this occurs, the fingers affected by Dupuytren’s contracture can’t be straightened completely. This seems like an innocent problem but it makes everyday activities such as putting your hands in your pockets, putting on gloves or even shaking hands difficult.
A number of treatments are available to relieve the finger contractures of Dupuytren’s. Surgery is the most commonly used. This requires incisions and cutting out of the contarcted cords so the flexor of the finger can go to full extension. While this is initially very successful, the recurrence rate is significant and recurrent cord formation is not uncommon.
An injection method for the non-surgical treatment of Duputryen’s contracture was approved by the FDA earlier this year. Xiaflex, manufactured by the Auxilium company, has been shown to release the contracted cords of Duputryen’s within a day after injection. Xiaflex is a collagenase enzyme derived from the clostridium histolyticum bacteria. It breaks down scar tissue in a rapid and aggressive fashion.
In my Indianapolis plastic surgery practice, I do not perform hand surgery and have not done so since my plastic surgery training a long time ago. I was unaware of Xiaflex until a relative of mine asked me to do the injections for him. He had a Duputryen’s contracture of his ring finger on his left hand which started five years ago. After receiving injection training from the manufacturer, I performed the 0.25ml injection with a 27 gauge needle along the cord in the palm. It was only mildly uncomfortable for him. He had some mild discomfort and soreness within the hour as well as some swelling over the injection site. When he came back the next day for the planned release (popping of the finger out to full extension), he already had a near complete release which happened on its own. He told me that it had started to release and get more loose that very night. I easily completed the finger release and put him in a splint that he is to wear at night for the next month. He can continue to stretch the finger out several times a day, an at-home physical therapy program if you will.
While I am not a hand surgery expert, I do not know from my plastic surgery training that Duputryen’s contracture is a difficult problem. Surgical release is associated with a high recurrence rate and the hand is disabled during the recovery period. Xiaflex, in my single case experience, was very effective with minimal recovery and immediate initiation of physical therapy.
Dr. Barry Eppley
Indianapolis, Indiana