Dupuytren's Disease updates Needle Aponeurotomy and Xiaflex are on Facebook
Dupuytren's Disease updates Needle Aponeurotomy and Xiaflex are on Facebook
Needle Aponeurotomy and Xiaflex update from the Hand Center of Western MA
What are the treatment options for Dupuytren's disease?
In mild cases especially if hand function is not affected, only observation is needed.
For more severe cases various techniques are available in order to straighten the finger(s). Your treating surgeon will discuss the method most appropriate for your condition based upon the stage of the disease and the joints involved. The goal of any treatment is to improve finger position and thereby hand function. Despite treatment the disease process may recur. Before treatment, your doctor should discuss realistic goals and results.
Types of treatment may include Needle Aponeurotomy, Partial or Complete Fasciectomy, and limited release as well as on Collagenase injections or cortisone injection in a nodule. The rationale behind each treatment depends upon the treating physician and the patient.
Surgical Fasciectomy (Partial or Complete) uses open incisions and the cords and nodules are removed
Incisonal Aponeurotomy or Fasciotomy uses small incisions or portals and the cords are released or perforated
Needle Aponeurotomy (NA) or Percutaneous Aponeurotomy (PA) or Percutanoeous Needle Fasciotomy (PNF)Needle aponeurotomy uses a small gauge needle or a microblade as a cutting device to sever the abnormal cords of tissue in the palm and digits which cause the fingers to flex down. The tissue is not removed it is essentially perforated or cut in multiple places along the palm to release the contracture (see figure 3) Incisional aponeurotomy fasciotomy is done in some instances.
Collagenase Injection (Xiaflex)
Collagenase is an enzyme that digest collagen a structural protein in tissues. Xiafllex is a collagenase derived from the bacteria Clostridium Histolyticum. Xiaflex is a mixture of several types of collagenase, titrated to achieve digestion of tissue or cords that are present in the hands of those who have Dupuytren's disease. (Figure 4)
Corticosteroid Injection (cortisone shot)
When a steroid or cortisone injection is given to the palm, in a nodule or small cord it will often soften the cord. There are studies that state that this may limit progression of the disease While there have been no large scale prospective double blinded studies or dose dependent studies many surgeons now will attempt to inject a nodule or soft cord that is not ready for surgery in an attempt to treat it.
IMPORTANT considerations:
What are the treatment options for Dupuytren's disease?
In mild cases especially if hand function is not affected, only observation is needed.
For more severe cases various techniques are available in order to straighten the finger(s). Your treating surgeon will discuss the method most appropriate for your condition based upon the stage of the disease and the joints involved. The goal of any treatment is to improve finger position and thereby hand function. Despite treatment the disease process may recur. Before treatment, your doctor should discuss realistic goals and results.
Types of treatment may include Needle Aponeurotomy, Partial or Complete Fasciectomy, and limited release as well as on Collagenase injections or cortisone injection in a nodule. The rationale behind each treatment depends upon the treating physician and the patient.
Surgical Fasciectomy (Partial or Complete) uses open incisions and the cords and nodules are removed
Incisonal Aponeurotomy or Fasciotomy uses small incisions or portals and the cords are released or perforated
Needle Aponeurotomy (NA) or Percutaneous Aponeurotomy (PA) or Percutanoeous Needle Fasciotomy (PNF)Needle aponeurotomy uses a small gauge needle or a microblade as a cutting device to sever the abnormal cords of tissue in the palm and digits which cause the fingers to flex down. The tissue is not removed it is essentially perforated or cut in multiple places along the palm to release the contracture (see figure 3) Incisional aponeurotomy fasciotomy is done in some instances.
Collagenase Injection (Xiaflex)
Collagenase is an enzyme that digest collagen a structural protein in tissues. Xiafllex is a collagenase derived from the bacteria Clostridium Histolyticum. Xiaflex is a mixture of several types of collagenase, titrated to achieve digestion of tissue or cords that are present in the hands of those who have Dupuytren's disease. (Figure 4)
Corticosteroid Injection (cortisone shot)
When a steroid or cortisone injection is given to the palm, in a nodule or small cord it will often soften the cord. There are studies that state that this may limit progression of the disease While there have been no large scale prospective double blinded studies or dose dependent studies many surgeons now will attempt to inject a nodule or soft cord that is not ready for surgery in an attempt to treat it.
IMPORTANT considerations:
- The presence of a lump in the palm does not mean that surgery or treatment is required or that the disease will progress.
- Correction of finger position is best accomplished with milder contractures and contractures that affect the base of the finger. Complete correction sometimes can not be attained, especially of the middle and end joints in the finger. no matter what method is used.
- Skin grafts are sometimes required to cover open areas in the fingers if the skin is deficient during open fasciectomy or open removal of cord tissue..
- The nerves that provide feeling to the fingertips are often intertwined with the cords and may be affected by any treatment
- Splinting and hand therapy are often required after surgery or other treatment procedures in order to maximize and maintain the improvement in finger position and function.
- All treatments for Dupuytren's may involve the risk of tendon, nerve, joint, skin: injury, infection, and stiffness. as well other conditions that may negatively affect the result.
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