Sunnybrook Health Sciences Centre
Division of Plastic Surgery
2075 Bayview Avenue M-Wing First Floor
Toronto, ON Canada
Dr. Paul A. Binhammer MSc, MD, FRCS(C)
Sunnybrook Plastic Surgery Associates
Hand Wrist and Microvascular Surgery
1. What is Dupuytren’s Contracture?
Pronounced “DOOP-atren”, it is a common condition that affects the palm and fingers. The fibrous tissues in your palm (Palmar Fascia) become very thick causing your fingers to pull downwards into a permanent bend, creating a “contracture”
2. How fast does Dupuytren’s progress?
It is not possible to predict how quickly or if at all Dupuytren’s will progress, however we do know that it is more likely to progress in males and seniors
3. What are my treatment options?
There are three options for treatment; Xiaflex injections, Percutaneous Needle Aponeurotomy (PNA) and surgical excision
4. What is Xiaflex?
Xiaflex is a drug composed of an enzyme called “Collagenase” that breaks down collagen. Under local anesthesia this drug is injected into the affected cord(s) at multiple locations in the finger(s). Once injected a reaction occurs causing bruising, pain and swelling. This usually happens in the hand, but in some cases can extend to the armpit. Over a period of days the drug will start to dissolve the collagen, breaking down the cord, allowing for the Doctor under local anesthetic to straighten the finger at a scheduled 1 week follow-up
5. What is the recovery time for Xiaflex Injection?
Recovery is 2 weeks with no heavy lifting. At your follow-up, a splint will be fitted to your hand by our Occupational Therapist to be worn at night time only for 3 months(do not wear your splint in the shower); starting cost for splints range from $40 - $180
6. What is the success rate for Xiaflex injection, and are there side effects/risks?
Xiaflex works about 85% of the time in most cases. Common side effects are skin splitting open (band aids are required), small risks of infection and scar tenderness, broken tendon and numbness are permanent. The chance of Dupuytren’s recurring with the use of Xiaflex injection is 10-30% over 3-5 years
7. Is Xiaflex free, or do I need to pay for it?
The Xiaflex drug costs around $1300.00 per injection; unfortunately the drug is not covered by the Ontario Government. Some insurance companies will offer full coverage or if not half coverage. If during your initial consult you choose to have the Xiaflex injection done, the Doctor will have you fill out a drug enrollment form. This form is then sent to the affiliated pharmacy for pre-approval.
8. How do I schedule my Xiaflex injection appointment?
Once you have been pre-approved for the Xiaflex drug, our office will contact you to schedule your injection appointment, as well as a 1 week follow up.
9. What is Percutaneous Needle Aponeurotomy or (PNA) or (NA)?
It is a procedure performed in our clinic under local anesthesia. A needle is used to break up the collagen fibers so that your finger can be made straighter. Band aids are applied, and a splint is fitted to the hand by our Occupational Therapist right after the procedure is done; splints range from $40 - $180
10. What is the recovery time for PNA?
The patient is able to proceed with light activities with no restrictions within a week after the procedure is done. A splint is worn for 3 months at night time only (do not wear your splint in the shower). A follow up with the Doctor is usually booked within 5-7 weeks after the procedure is done, to make sure that the hand is progressing properly
11. What is the success rate for PNA and are there side effects/risks?
There is a small risk of infection, scar tenderness and numbness that is permanent. The chance of Dupuytren’s recurring is about 40% over 3-5 years
12. What is surgical excision?
It is a procedure done in the hospital operating room. An incision is made to remove the thickened cord in order to straighten your finger(s) as much as possible. Sutures are put in the skin, and a plaster splint is put in place to be worn at night for 3 months (do not wear your splint in the shower); starting cost for splints range from $40 - $180
13. What is the recovery time for surgical excision?
After surgery you will be referred to see a therapist to start an exercise program to help with the risk of stiffness and/or permanent loss of motion from occurring. Therapy lasts about 2-3 months. As well, a 1 week follow up is booked for the sutures to be removed
14. What is the success rate for surgical excision and are there side effects/risks?
There are small risks of infection, scar tenderness and permanent numbness. The chance of Dupuytren’s recurring is about 25% over 3-5 years
Link to Xiaflex website
Link to Dupuytren Foundation Youtube video