Latest Technique - Needle Fasciotomy or Xiapex (Collagenase) Injection

This technique is used as a minimally invasive procedure for Dupuytren's contracture of the hand. It is done under a local anaesthetic and involves breaking up the Dupuytren's tissue with a hypodermic needle and a manipulation to try and correct the deformity.  There are usually no stitches but the wounds are just covered with a plaster and patients are usually free to mobilise the hand straight away.

This technique breaks up the Dupuytren's tissue but does not remove the Dupuytren's tissue itself. Therefore, there is a risk of recurrence of a contracture. However, the recovery following this procedure is a lot quicker than having a fasciectomy which involves a much bigger scar and wound.  Fasciectomy requires a lot of splintage and hand therapy delaying return to work and normal function of the hand. 

The needle fasciotomy is similar to what has been described in the press recently, involving injection of collagenase - Xiapex, which is an enzyme drug that breaks up some of the Dupuytren's tissue.  It is gradually being introduced in the UK but with strict criteria for its use.

Whilst there is certainly evidence that the drug works, the results are probably similar to needle fasciotomy in terms of correcting the deformity and contracture.  If the needle fasciotomy is not successful, or if there is a recurrence, then one can always proceed to a more involved surgical procedure in the form of fasciectomy. Certain types of Dupuytren's disease in terms of the location and proximity to digital nerves make the use of the needle fasciotomy and collagenase inappropriate. This would be discussed in detail at your consultation.

The photos below provide more information about the procedure.

Note:- All these images are copyright to Mr JJ Southgate and may not be copied or reproduced without permission. High quality pictures may be available on request.

Dupuytren’s Contracture (Dupuytren's Disease) and Needle Fasciotomy Operation in Pictures Photo of the hand before operation showing the extent of the movement. View Large Image

Another view of the hand before operation showing the extent of the movement. View Large Image

Close up view of the little finger before the operation. View Large Image

Needle Fasciotomy Operation started View Large Image

Breaking up the Dupuytren's tissue with a hypodermic needle View Large Image

View of progress View Large Image

More breaking up the Dupuytren's tissue with the hypodermic needle View Large Image

Application of Dressing after the procedure After Needle Fasciotomy Operation View Large Image

Application of initial dressing View Large Image

Dressing View Large Image

Finished dressing View Large Image

Follow up two weeks after the operation Dressings are off View Large Image

Another view View Large Image

Follow up two weeks after the operation - the improvement Follow up two weeks after the procedure shows the improvement to movement. View Large Image