Xiaflex® is an FDA-approved injection treatment for adults with a condition known as Dupuytren’s Contracture.
It is a solution of enzymes that injects directly into the Dupuytren’s fibrous cord and can be felt between the palm and the fingers. The enzymes (purified collagenase clostridium histolyticum) break down the cord, but not the surrounding tissues in the hand, allowing the fingers to straighten. It is an effective alternative to surgery, which has been the traditional treatment for this condition.
Studies indicate that the majority of patients achieve an excellent reduction of their contracture; many achieve completely straight fingers. This treatment has been shown to be more effective in the lowest finger joints to the palm (metacarpophalangeal or MCP joints) than in the middle joints of fingers (proximal interphalangeal or PIP joints). The injection is performed to allow the fingers to straighten and address the contracture, if present. However, it may not always remove or reduce every palpable lump/bump on the palm or fingers.
Treatment with Xiaflex® is a 3-day process that includes the injection of the solution, finger extension, and fabrication of a night-time splint.
Approximately one to seven days after the injection, your physician will carefully extend the injected finger to help release the cord. As many as three injections may be given into the cord of an affected finger or joint. No more than two fingers or joints may be injected per treatment. Patients must wait a minimum of 30 days to have Xiaflex® treatment for another finger.
It is important to carefully follow these instructions:
Remove all jewelry from the affected hand, including rings, watches and bracelets as a certain amount of swelling and bruising typically occurs following a XiaflexÒ injection.
- Your hand will be placed in a soft dressing to provide some padding over the injection site.
- Keep your hand elevated as much as possible to minimize swelling. At bedtime you can elevate the hand with one or two pillows.
- Do not use ice for the first 48 hours after the injection of Xiaflex® as this may reduce its efficacy.
- While your cord may release spontaneously, do not attempt to forcefully disrupt or straighten the injected finger. You will see your physician in one to seven days for a finger extension procedure which is performed under local analgesia.
- Following the finger extension, a hand therapist will fit you with a custom splint to wear at night to keep the finger straight. This should be worn for as many as four months.
- Your hand therapist will prescribe a series of daily finger flexion and extension exercises to improve your finger motion and limit the formation of scar tissue.
- Do not perform any heavy gripping or weight lifting for one month after the injection.
POSSIBLE SIDE EFFECTS
Xiaflex® treatment is likely to cause temporary swelling, bruising, bleeding, itching and/or pain at the injected site and surrounding tissue. Bruising may occur all the way up the arm. This typically resolves within a few days. Transient swelling of the lymph nodes (glands) in the elbow or underarm may also be noted.
- Small skin tears at the injection site may occur following the finger extension procedure and will typically heal within a week. If a skin tear develops, it is covered with a small dressing until healed.
- Rare but serious complications of Xiaflex® injection include tendon ruptures and ligament injury. In the initial controlled trials, flexor tendon rupture was observed in 0.3% of 1,082 patients. If a tendon becomes weak and ruptures, surgery may be required. Call your doctor right away if you are unable to bend your finger (towards the wrist) after the swelling goes down.
- Allergic reactions are possible after an injection of Xiaflex® because it contains foreign proteins. If you experience a swollen face, breathing trouble or chest pain call 911 or go to the hospital ER.
- NOTE: Recurrence of contracture can occur after either surgery to remove the entire cord or after Xiaflex® injection to dissolve the cord. Xiaflex® treatment can be repeated if recurrence develops.
- If you have questions for your physician, please send a message via the online ONS Patient Portal. Your message will be answered promptly.