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London Hand and Wrist Unit

Dupuytren’s disease is a common

condition of the hand which, although

painless, causes functional problems.

It typically affects the little and ring

fingers, but may affect all areas of the

hand. The traditional treatment for

Dupuytren’s disease has been surgical

excision of the affected disease of the

hand, so-called regional fasciectomy.



(Pfizer) is the commercial

name for the collagenase clostridium

histolyticum enzyme which, after

extensive research and published

randomised trials, has been found to

effectively and safely release the cord

in Dupuytren’s without surgery.

Referral to a Consultant who is

trained and experienced in the use

of Xiapex™ is important. The

Consultant will decide whether or

not this is an appropriate treatment

to use, as it is not applicable for all

patients with Dupuytren’s. Treatment

involves injection of the enzyme

into the Dupuytren’s cord to break

it down. After the enzyme has been

injected, the patient is warned that

there is likely to be some bruising and

swelling in the hand, and during this

time they should not use the hand

for vigorous activities including sport.

Approximately 24 to 48 hours after

the initial injection, the patient is seen

again by the Consultant to rupture the

cord, under local anaesthesia, if this has

not occurred spontaneously. The skin

may occasionally tear a little after the

extension procedure. These skin tears

heal rapidly. Following the release,

night-splinting is recommended,

and a hand therapist will fabricate a

removable night extension splint to

wear whilst ensuring a good range of

movement of the finger is regained.

The great benefit for the patient is

that firstly, the procedures are carried

out in the Outpatients Department,

and secondly, there is far less time

spent in rehabilitation, with an early

return to normal everyday activities

including work and sport. The

advantage of enzymatic release of

the cord over percutaneous needle

fasciectomy may also be a longer

period free from recurrence.

New Non-Surgical


Collagenase injection – introducing a new

non-surgical treatment for Dupuytren’s contracture.

Our Hand Surgery Consultants, Mr Rupert Eckersley at 31Old Broad Street and Mr Raj Ragoowansi at City of London Medical

Centre, offer this treatment. The treatment is covered by most insurance companies, though as yet it is not readily available in

the NHS. For further information or to arrange an appointment, please contact The London Hand and Wrist Unit on:

T: 020 3214 3617

or visit

London Hand andWrist Unit