New Hand Disorder Treatment

April 9, 2014 Jeffrey Scott

Jeffrey Scott, MD is Plastic Surgeon at Providence Mill Creek - Plastic & Reconstructive Surgery. He has a special interest in caring for patients with cancer or trauma injuries, as well as cosmetic surgeries of the face, neck and body.

Leonard Maine, a 48-year-old Snohomish resident, was not surprised when some of his fingers on both hands started to contract and bend toward his palms.

“I knew what it was. My dad, my brother and my grandfathers on both sides have it.”TYH_Scott_Hands

Leonard has Dupuytren’s contracture, a potentially debilitating condition that affects the connective tissue in the palm of the hand. A buildup of excess collagen forms rope-like cords of tissue, which eventually keep the fingers from relaxing and straightening. The disorder is most common in Caucasians and in men over age 50.

Leonard’s condition was progressing; his fingers had started curling more than a decade before, in his mid-30s. “I was down to two usable fingers,” he says. “I couldn’t put on gloves, or put my hands in my pockets.” Several fingers bent almost into his palms.

Still, he was not eager to undergo surgery. “I opted out of surgery after seeing what that was like for my dad and his brothers,” Leonard says. But then, Leonard’s uncle found plastic and reconstructive surgeon Jeffrey Scott, MD, and discovered another option.

A Welcome Advance

Xiaflex, a biologic drug made from living proteins, was approved by the FDA in 2010 for treating Dupuytren’s contracture.

“This was probably the biggest technological advance I’ve seen since I started my surgical practice,” Dr. Scott says. “It really is a game changer, because it is very effective and it allows most patients with this disorder to avoid surgery—and all the risks and recovery that go with it.”

Xiaflex is injected directly into the collagen cord of the hand, where it breaks down the excessive buildup of collagen. (Xiaflex should be administered only by a medical professional who is experienced with injections of the hand.) No anesthesia or incisions are required. There is no prolonged recovery. There may be a need for some postoperative hand therapy. Patients may experience some bruising or swelling at the injection site for a few days, but can use their hands immediately after treatment.

Dr. Scott says the results using Xiaflex are at least as good as with surgery. “The bending of fingers is likely to recur, but the injection can be repeated as needed,” Dr. Scott says. “Many patients with Dupuytren’s will probably be able to avoid surgery for this disorder their whole life.”

Dr. Scott says the drug is being studied for other applications as well. In December 2013 the FDA approved its use as the first non-surgical treatment for Peyronie’s disease, a condition that causes penis curvature. In addition, Xiaflex is expected to be effective for treating certain podiatric and orthopedic conditions; research is underway.

“Ecstatic” Results

Leonard says he couldn’t be happier with the results. “I recommend this wholeheartedly to others with the disease. Just get in early. Don’t wait like I did, with my ring finger so far bent,” he says. “Once you notice the cord forming, get in as soon as possible.”

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