• Medico-Legal Work
  • Fees
  • CV

XIAPEX OFFERS TREATMENT FOR DUPUTREN’S CONTRACTURE THAT WORKS AS AN ALTERNATIVE TO SURGERY.

XIAPEX is a mixture of two collagenases produced by the bacterium C. histolyticum. The two enzymes have complementary substrate specificity, as they cleve interstitial collagen at different sites. The product is injected directly into the cord of tissue responsible for the contracture, causing collagen lysis and cord disruption.

Collagen is the standard building block for soft tissues of the body and comes in different types. There are four types and Types 1 & 3 are present within Dupuytren’s tissue. Collagenase is an enzyme that was originally found in a bacterium called clostridium histoliticum. Unfortunately the collagenase itself can also attack ligaments and tendons and potentially blood vessels, but allegedly not nervous tissue.

The treatment involves an injection on Day 1 under local anaesthetic and then the patient is required to attend on Day 2 for a manipulation of the finger to attempt to straighten it under another local anaesthetic. The patient will then go immediately for a splint to be made and the splint will need to be worn at night for three months. One of the problems with the injection is bruising and wound problems, so you would require a follow up at one week and two weeks following the injections. Mr Field’s fee covers the first two days of treatment. Sometimes it may be necessary to repeat the treatment to gain full benefit.

The trials that have been performed on about 600 patients show that 44 - 64% have a completely straight finger or near straight hand after up to 3 injections. The average number of injections is 1.7. At two years following the injection, there is a 20% recurrence. We have no longer term studies to determine what the recurrence rate will be over the long term.

Important information about Xiapex

• Xiapex can cause serious side effects including tendon or ligament damage. Receiving an injection of Xiapex may cause damage to a tendon or ligament in your hand and cause it to weaken or break. This may require surgery to fix the damaged tendon or ligament. If you have any trouble bending the injected finger towards the wrist following the injection you must return immediately to see Mr Field.
  
  
• Nerve injury or other serious injury to the hand if there is any form of numbness, tingling or increased pain in the treated finger please contact Mr Field.

Allergic reaction can occur in patients injected with Xiapex as it contains foreign proteins. You must inform your GP or Mr Field if you experience any symptoms of allergic reaction such as hives, swollen face, breathing difficulty or chest pain.

Dupuytrens contracture little finger before treatment

1 day after the injection - note not manipulated yet - also note degree of bruising

After manipulation. Note: some skin splits - these heal uneventfully after 1-2 weeks

Finger at 3 months after collagenase injection. Note: full correction of deformity has been maintained.