What are Xiapex collagenase injections?
Xiapex is a new treatment for Dupuytren's disease. Xiapex is a mixture of collagenase enzymes which digests and breaks the collagen that is in the rope-like Dupuytren's cords. This weakens the cords to such an extent that the cord will occasionally break by itself, but more commonly requires a finger straightening procedure that I perform at least a day after the injection.
How are Xiapex injections given?
Visit 1: Xiapex is prepared and injected directly into one of the Dupuytren cords through a very small needle. Local anaesthetic is not usually given for this injection as it stings as much (if not more) than the Xiapex injection itself.
Visit 2: 1 to 8 days later you need to return for a review and to assess for the need for a straightening procedure. This is often called the "snap" procedure, as frequently a snap is heard as the cord breaks during the straightening procedure. Local anaesthetic may be used during this second visit, depending on how sore and swollen the hand is.
Xiapex is a new treatment for Dupuytren's disease. Xiapex is a mixture of collagenase enzymes which digests and breaks the collagen that is in the rope-like Dupuytren's cords. This weakens the cords to such an extent that the cord will occasionally break by itself, but more commonly requires a finger straightening procedure that I perform at least a day after the injection.
How are Xiapex injections given?
Visit 1: Xiapex is prepared and injected directly into one of the Dupuytren cords through a very small needle. Local anaesthetic is not usually given for this injection as it stings as much (if not more) than the Xiapex injection itself.
Visit 2: 1 to 8 days later you need to return for a review and to assess for the need for a straightening procedure. This is often called the "snap" procedure, as frequently a snap is heard as the cord breaks during the straightening procedure. Local anaesthetic may be used during this second visit, depending on how sore and swollen the hand is.
What are the risks of Xiapex collagenase injections?
As with any procedure on the hand, Xiapex can cause bleeding, infection, pain, swelling, scarring and very occasionally an abnormal pain reaction (1 in 4000) in the hand. However short-term pain and swelling is somewhat more common following Xiapex compared to other procedures.
Specific risks from Xiapex are:
- bruising (see photo)
- skin tears, especially during the straightening procedure. Normally these are small, and can simply be dressed until they heal.
- tenderness up the arm, or even under the armpit
- allergic reaction (very rare)
As with any procedure on the hand, Xiapex can cause bleeding, infection, pain, swelling, scarring and very occasionally an abnormal pain reaction (1 in 4000) in the hand. However short-term pain and swelling is somewhat more common following Xiapex compared to other procedures.
Specific risks from Xiapex are:
- bruising (see photo)
- skin tears, especially during the straightening procedure. Normally these are small, and can simply be dressed until they heal.
- tenderness up the arm, or even under the armpit
- allergic reaction (very rare)
What can I do to help?
To reduce the amount of swelling and pain you must keep your hand elevated above the level of your heart. Keeping the hand cool can also help. One safe and easy way to do this is to wrap a moist tea towel around a bag of frozen peas and gently hold it in your hand for around 5 minutes every hour.
Are Xiapex injections right for me?
The first thing to say is that not all GP practises (or more correctly CCG's) will pay for Xiapex on the NHS. However Xiapex is not suitable for everyone. In early Dupuytren's disease I favour needle aponeurotomy, and in advanced, extensive or revision Dupuytren's you are more likely to require open surgery (limited fasciectomy or dermofasciectomy). Xiapex is more suitable for the middle-ground patients.
To reduce the amount of swelling and pain you must keep your hand elevated above the level of your heart. Keeping the hand cool can also help. One safe and easy way to do this is to wrap a moist tea towel around a bag of frozen peas and gently hold it in your hand for around 5 minutes every hour.
Are Xiapex injections right for me?
The first thing to say is that not all GP practises (or more correctly CCG's) will pay for Xiapex on the NHS. However Xiapex is not suitable for everyone. In early Dupuytren's disease I favour needle aponeurotomy, and in advanced, extensive or revision Dupuytren's you are more likely to require open surgery (limited fasciectomy or dermofasciectomy). Xiapex is more suitable for the middle-ground patients.
Advantages of Xiapex?
- two short visits for treatment
- very effective treatment in correctly chosen patients
Disadvantages of Xiapex?
- not available to all patients on the NHS
- may take a few weeks for pain and swelling to completely settle, and recovery will be even longer if skin tears occur
- the licence for Xiapex is to inject only one cord at a time, so that only one joint of one finger can be straightened at one time. However I am more flexible than this, having used Xiapex effectively in more than one finger with great effect in specific patients in the past.
- two short visits for treatment
- very effective treatment in correctly chosen patients
Disadvantages of Xiapex?
- not available to all patients on the NHS
- may take a few weeks for pain and swelling to completely settle, and recovery will be even longer if skin tears occur
- the licence for Xiapex is to inject only one cord at a time, so that only one joint of one finger can be straightened at one time. However I am more flexible than this, having used Xiapex effectively in more than one finger with great effect in specific patients in the past.
