My surgeon is offering a new injection treatment for my Dupuytrens disease. I'm not sure about it. What are the pros and cons of this treatment?
Dupuytrens disease is a disorder that affects the palm side of the hand. It most often affects the ring or little finger, sometimes both, and often in both hands. This is where a type of connective tissue, called fascia that surrounds and separates the tendons and muscles of the hand is involved. Just under the palm is the palmar fascia, a thin sheet of connective tissue shaped somewhat like a triangle. The condition commonly first shows up as a thick nodule (knob) or a short cord in the palm of the hand, just below the ring finger. More nodules form, and the tissues thicken and shorten until the finger cannot be fully straightened. Dupuytrens contractures usually only affect the ring and little finger. Treatment for this problem has always been surgery. Heating and manually stretching the tight tissues doesn't solve the problem. Cutting the hand open and releasing the tight cords has been the only effective treatment. Now, with the recent FDA approval of a new injectable drug (Xiaflex), the cord can be treated conservatively (nonsurgical approach). By injecting an enzyme directly into the cords formed by the disease, the tissue dissolves and starts to weaken. Then the surgeon can manually pull the fingers straight and rupture the cord. That sounds dramatic -- it's not! The treatment is safe and effective. There are a few possible (minor) side effects but very few major or long-term complications with this new treatment. During the control trials conducted with patients, most people had a local skin reaction (redness, skin tears, itching or stinging) where the injection went into the skin. During the testing phases and research trials, a small number of more serious problems developed. Only a few patients were effected. Complications reported included tendon rupture, finger deformity, and hives that had to be treated with medication. Treatment with injected collagen (called enzymatic fasciotomy) may eventually replace surgery. But further study is needed to assess the long-term effects, especially recurrence rates. Until then, surgical release of the cords will likely remain the gold standard.