Collagenase injection

Xiapex injection
Summary

This procedure is performed for Dupuytren’s disease.  The aim is to inject an enzyme into abnormally thickened tissue in the palm to chemically divide it. This leads to a straighter finger and an improvement in function.  

Factors to Consider

Symptoms from Dupuytren’s disease vary significantly between patients.  Many people will find that the position of the finger gets in the way during day to day tasks.  Without treatment the bend will typically get worse, though the timescale can be very variable. The severity of your symptoms will dictate whether you should proceed to surgery.

Non-surgical treatments such stretching and splints are typically not effective. There are a number of surgcial options which are suitable in different situations. These include needle fasciotomy, collagenase (Xiapex) injection and fasciectomy . Your surgeon will be able to discuss which of these are the most appropriate.  

Collagenase is suitable in some circumstances and depends on the pattern of your Dupuytren’s disease. It is a simpler procedure than fasciectomy as it is done as an outpatient. A manipulation procedure is needed between 1 and 3 days after the injection to straighten the finger. This is often done with local anaesthetic. There are a few circumstances in which it is not recommended.

Description of Surgery

The procedure is performed in clinic, but not on the same day as your initial appointment. You will need to ensure that there is someone to drop you off and pick you up from the hospital. You will need to remove any rings and jewelery from the hand.

The injection is performed using a small needle in the palm.  The surgeon will identify the abnormal tissue and inject a very small volume of the enzyme into it. Stitches are not needed.  The procedure itself is very quick. You will be asked to wait for about 30 minutes after the procedure to monitor for any signs of an allergic reaction (see below).

The manipulation procedure is also done in clinic after local anaesthetic. Again you should have someone to drive you home afterwards.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The most common symptoms after this procedure are swelling and bruising in the palm. This happens in most patients and is a little uncomfortable, but not usually more than that.

The risk of infection is very small and is thought to be less than 1%.  Most infections will settle simply with antibiotics.

Damage to nerves and blood vessels and tendons to the finger can occur, though the risk of them being damaged is very small.

The finger position is usually improved, though it may not go fully straight. There is a chance it may not improve, but further surgery is not compromised by trying this approach.

A skin tear can develop as the finger is straightened though this typically heals rapdily. This is more common if the skin is adherent to the abnormal tissue.

Some stiffness and swelling is common and usually resolves rapidly with elevation and movement of the fingers. Complex regional pain syndrome is a rare complication that may cause more prolonged pain, stiffness or swelling.

There is no cure for Dupuytren’s disease and it will often recur over a number of years. Rarely this can be more rapid.

Allergic reactions can occur but are typically not severe. Some discomfort further up the arm or in the armpit is not uncommon and usually is not severe and settles quickly. More serious allergic reactions are theoretically possible and are the reason for monitoring after the injection.

After Surgery

Pain

The initial injection is not usually too sore, but simple pain relief might be needed.  

Dressings

A simple dressing is usually all that is needed.

You may be given a sling to help keep the hand up whilst walking about. This helps reduce swelling, but you can come out of it to move the shoulder and elbow.

Physiotherapy

The hand is then free to move straight away and the therapist will see you to see if you need any help to mobilise the hand.

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road.  This will vary between patients but normally will be within a week or two.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a couple of days of your surgery.  If you have a heavy manual job it can take longer before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Your finger should be improved after the manipulation though it may take a few weeks before it feels back to normal.