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Dupuytrens Surgery and Xiaflex Injection

Dupuytren’s contracture patientDupuytren’s contracture occurs in the hand when the palmar fascia — the tissues which cover the finger’s tendons, nerves and blood vessels — thickens, shortens and draws the fingers towards the palm of the hand to prevent full extension. In most cases, the condition primarily affects the small and ring fingers, although any digit can be involved. It will often occur in both hands. If left untreated, the contracture can lead to a fixed flexion of the finger joints, causing a significant impact on the function of the hand.

Researchers continue to study the causes of Dupuytren’s contracture and note that heredity factors play a role in who will develop the condition. Men over the age of 40, for example, and individuals of Western European heritage have a higher incidence of diagnosis than others. Fortunately, the condition, while disabling, is rarely painful and surgeons can treat it and its symptoms with effective non-surgical procedures or, in more complex cases, surgery.

How is Dupuytren’s Contracture treated?

There are 2 options for treatment; surgery or collagenase injection. The decision about the most appropriate treatment is made by your surgeon and is dependent on a number of factors, including the duration and severity of disease.

Percutaneous collagenase injection (Xiaflex) — Can be performed by your Specialist Plastic Surgeon at Niche Plastic Surgery — is a convenient non-surgical treatment that can improve the symptom’s associated with milder forms of Dupuytren’s contracture. It is a two stage office procedure that initially involves the injection of collagenase to the cords and knots causing the contracture, this breaks down the linking proteins in the tissue. The second stage is completed a few days later when the affected digit is manipulated straight under local anaesthetic.

When patients have more severe symptoms, often involving multiple digits or with prolonged contactures of the proximal joint of the fingers, they need a surgical procedure called a fasciectomy. This is a hospital based procedure that is typically completed as a day case. You will often require a general anaesthetic. The surgery removes all the diseased Dupuytren’s tissue and straighten’s the affected joints while preserving the important underlying tendons, nerves and blood vessels. Depending on the severity of your disease the skin closure may be in a zig zag pattern or require a skin graft.

Recovery From Your Dupuytren’s Contracture Procedure

Your recovery will differ depending on the type of treatment your symptoms require. If you have a Xiaflex injection there are no wounds or incisions to heal so the recovery is much faster. Immediately following the second stage manipulation procedure you are free to use the hand as tolerated. The hand will remain a little swollen and sore for 7 to 10 days during which time you will slowly increase your level of activity. We encourage you to use the hand as much as possible during the day and rest in a custom thermoplastic splint at night.

Recovery from surgery will vary depending on the extent of your disease, but it can be up to 12 weeks before you are using the hand normally. Patients are typically discharged from hospital in a splint and arm sling that will immobilise the whole hand until your first post-op appointment at 5 – 7 days. We will often arrange for you to be seen by a specialist hand therapist to manage your recovery and provide you with a custom resting splint. Patients will need dressings until the wounds are healed and should expect to have only minimal use of the operated hand for the first two weeks.

Results From Your Dupuytren’s Contracture Treatment

Regardless of which treatment, you will have substantially improved range of movement in your affected fingers after the procedure. Some patients may not regain full extension of their fingers because of the severity and duration of contracture, but treatment will provide a significant functional improvement. There is a long term risk of disease recurrence following both surgery and collagenase injection that may require additional interventions in the future.

Schedule Your Dupuytren’s Contracture Consultation Today at Niche Plastic Surgery

Dupuytren’s Contracture can severely limit your abilities to perform even routine daily functions, and the appearance of the affected hands can also cause self-consciousness. Niche Plastic Surgery’s Specialist Plastic and Reconstructive Surgeons have extensive training and experience in treating Dupuytren’s Disease and restoring function to the hand.

Call Niche Plastic Surgery on 9853 9705 to arrange for your in-person consultation and learn more about your Dupuytren’s Contracture treatments options today.