Dupuytren Contracture Procedure Choices
If a hand progresses from early Dupuytren disease (nodules, dimples, cords with no limitation of motion) to Dupuytren contracture, treatment should be considered. The best compromise between the ordeal of a procedure and the best long term outcome is to treat either when the finger is either awkwardly bent or if the bend of one joint […]
Dupuytren Roundtable Discussions
Here are links to two recently published roundtable discussions by experts in the field of Dupuytren’s. Although these were discussions by surgeons for surgeons, they are really just conversations and quite readable. They highlight the current challenges both surgeons and their patients face with Dupuytren’s disease and provide insight into future efforts to develop a […]
Stony Brook Dupuytren Symposium
I had the opportunity to attend the Stony Brook Dupuytren Symposium April 17. This was a real treat, featuring a faculty of well known authorities on Dupuytren’s. The volcanic ash European flight difficulties prevented attendance of only one speaker. The symposium covered a range of topics and in addition provided an in depth tour of […]
Personal experiences with Xiaflex and Needle Aponeurotomy
Xiaflex is now available, and is generating reports by both traditional writers and self published social media authors. There are now two minimally invasive treatments for contractures due to Dupuytren’s disease – Xiaflex injection and needle aponeurotomy – with relative advantages and disadvantages of each. The following video was made by a Dupuytren’s patient, documenting […]
Metalloproteinases and Dupuytren’s
A better understanding of the biology of metalloproteinases may lead to new treatment options for Dupuytren’s. Metalloproteinases (MMPS) are a group of enzymes in our bodies which break down certain proteins, including collagen. MMPS are blocked by tissue inhibitors of metalloproteinases (TIMPS). MMPS and TIMPS balance each other: imbalances have been implicated in conditions of […]
Xiaflex Pricing
Auxilium has moved closer to product availability of Xiaflex collagenase injection for the treatment of Dupuytren’s contracture by announcing the wholesale drug price: $3250.00 for a single treatment dose. For those who think that this seems high, consider this in perspective. There are many categories of pharmaceutical products. Most commonly available pharmaceuticals are classified as […]
Needle Aponeurotomy and Xiaflex compared
Xiaflex (Collagenase) has finally been approved by the FDA for the treatment of Dupuytren’s contracture. When work began on the development of collagenase to treat Dupuytren’s contracture, the bar was pretty low: anything better than fasciectomy in terms of either safety or efficacy would be a great advance. No other treatment options were available in […]
Genes, enzymes and Dupuytren’s: the alphabet name game.
A proteinase is an enzyme which breaks down proteins. Metalloproteinases (MPs) are proteinases with a molecular structure and function involves a metal atom, usually zinc. Matrix Metalloproteinases (MMPs) are MPs which act outside of cells, in the tissue matrix. Human collagenases are MMPs which break down different types of collagen. Membrane-type MMPs (MT-MMPs) are MMPs […]
LSD as a treatment for Dupuytren’s?
There is one published report of Dupuytren’s being cured, fingers suddenly straightened, under the influence of the psychedelic drug LSD (full text: https://dupuytrens.org/DupPDFs/1966_Solursh_1417.pdf). Is this true? Probably not. LSD is a serotonin antagonist, and other serotonin antagonist drugs, such as methysergide, have been shown to cause retroperitoneal and cardiac valve fibrosis. Based on this information, […]
FDA approves Collagenase for Dupuytren’s
Collagenase (Xiaflex) has been approved by the FDA for treatment of Dupuytren’s contracture, after years of intensive laboratory and clinical trials. Collagenase enzymatic fasciotomy is more similar to needle fasciotomy than to either open fasciotomy or fasciectomy in terms of rapid recovery and low complication rate. Compared to needle release, collagenase enzymatic fasciotomy should eventually […]
