Xiaflex® injection for Dupuytren's contracture
What is Xiaflex®?
· Xiaflex® is a prescription medication used primarily to treat Duputren's contracture, a condition where the fingers bend towards the palm due to thickened tissue, or cords, that form in the hand. Xiaflex® contains a purified enzyme called collagenase, which works by breaking down the excess collagen in the cords. This helps to release the contracture, allowing for improved finger movement and function.
What happens during and after the procedure?
· You will have two visits. During the first visit, Dr. Williams will numb the skin. She will then inject Xiaflex® at multiple locations along the cord and place your hand in a soft dressing which should stay in place for at least 24 hours.
· Over the next few days, the Xiaflex® will take effect, dissolving the collagen in the Dupuytren's cord wherever the medication was injected. During this time, the hand will likely become quite sore, swollen, and black and blue. Sometimes swelling can also occur in the armpit.
· You will return within 7 days for the manipulation. Dr. Williams will numb the skin. She will then gently manipulate the affected finger(s) into a straightened position. This will cause the Dupuytren's cord to rupture and allow the finger(s) to extend. She will then place your hand in a splint to hold the involved finger(s) in extension.
· Within a few days of the manipulation, you will see a hand therapist for a custom removable splint. This splint is to be worn at night for the next three months to keep the contracture from returning. It does not need to be worn during the day.
Activity following injection
· Plan to take it easy for two weeks following the injection. During this time, avoid forceful gripping or squeezing such as heavy manual work, tennis and golf.
Pain control following injection
· Xiaflex® is a powerful enzyme. Significant swelling and discomfort are common after the injection and manipulation. Elevation above the level of your heart will help with pain and swelling. A cold pack may also help. It can be used every 1-2 hours for 20 minutes at a time. Be sure to place a thin towel between the cold pack and exposed skin so that they are not in direct contact.
· If you have pain and are able to take these medications safely, we suggest taking Tylenol and Ibuprofen as needed after the injection and/or manipulation. These medications can be taken together and work together to make each other stronger. These medications should not be taken at the same time as other medications containing acetaminophen, ibuprofen, or other NSAIDs. Please refer to the instructions on the bottle for dosing instructions.
Do NOT take more than 3,000 mg Tylenol in 24 hours
Do NOT take more than 2,400 mg of Ibuprofen in 24 hours
Skin tears
· Skin tears are common following Xiaflex® injection, particularly for patients with more severe contractures. They can be quite dramatic but typically heal remarkably quickly and well.
· If you experience a skin tear, you will be given instructions on wound care and will need to perform simple dressing changes on a daily basis until the tear heals. The skin tear may delay your return to normal activity following the procedure.
· Some people believe that skin tears following Xiaflex® injections may reduce the risk of contracture recurrence. In that sense, while skin tears are uncomfortable and an inconvenience, they may actually have some benefit.
Can complications occur?
· Complications can occur related to Xiaflex® injection. Dr. Williams will discuss these with you during your consultation.