Lawsuits and Xiaflex injections

DCI does not advise about lawsuits when a problem occurs after a Xiaflex (collagenase) injection. However, we are aware of many people who pursue legal action brought about by an adverse result or bad outcome after a Xiaflex injection procedure – sometimes horrific. And we sense a growing number of lawsuits as the use of Xiaflex injections for Dupuytren’s contracture increases. As a third-party who receives only learns about lawsuits for Xiaflex injections via email and conversation, with no way to directly examine these unfortunate individuals. It is never clear if the fault lies with the Xiaflex drug directly or with the doctor who performed the procedure.

People tend to avoid drugs and surgery whenever possible; common sense dictates to be conservative when dealing with the body. Xiaflex injections are placed several millimeters below the skin surface without being able to guarantee the accuracy of the injection into the target fibrous tissue; the doctor cannot see the tip of the needle going into the cord, nor can the doctor know for sure how much Xiaflex might leak out into normal healthy tissue. This does not sound like a conservative procedure. Further, collagenase injection for DC has only been used for a few years. There is still a lot to be learned how to make Xiaflex injections safer with better results, as evidenced by the number of complaints and problems circulating on the internet and lawsuits related to bad reactions.

DCI is not against the use of Xiaflex injections as a Dupuytren’s treatment when other more conservative options have been unsuccessful. Even if only a small percent of people experience a bad outcome after receiving a Xiaflex injection, it is reasonable to consider the DCI non-drug and non-surgical Alternative Medicine options available – with no side effects after 14 years of use – that can be tried before using Xiaflex injections.

Below are five examples of some of the emails DCI receives from people who have had Xiaflex injections, along with Dr. Herazy’s response to them. This information is presented here so that readers might understand the full range of possible outcomes from the use of Xiaflex injections for their Dupuytren’s contracture.

1. –
Dr. Herazy,
Thanks for all this information about Dupuytren’s contracture and how to treat it naturally. I want to tell my story so others can hear what their doctor will not tell them about getting Xiaflex injections to dissolve the hand cords.
My uncle had Dupuytren’s contracture and he had a z-plasty many years ago and it crippled his hand badly. When I got DC I knew I did not want any part of hand surgery. So, three years ago I had Xiaflex injections for the cords in my dominant hand. Each shot hurt like crazy, but I nearly passed out the next day when the cords were broken. The skin split open and I was bleeding over everything. It felt like the finger was being broken in slow motion. Over the next few days the hand got more and more swollen and I could not move my fingers because of pain. I had large and small pockets of dying flesh on the palm and wrist. The doctor told me the Xiaflex was destroying the flesh, muscles and tendons were being eaten up along with the cord. My hand was a mess for three weeks because nothing the doctor did helped those open wounds to heal.
A plastic surgeon repaired what he could and after two surgeries the large open wounds started to heal up. He says I will never be the same because I have permanent nerve damage and loss of muscles and weak tendons. The worst part is behind me now, even though I probably will always have pain in my hand, and my fingers do not move easily, and I have bad scars over the palm, wrist and two fingers.
I think I was too quick to trust a doctor who is not a hand specialist with a delicate procedure where he could not actually see where the Xiaflex injections were going when he did it. I did not know until later that the doctor has to feel around under the skin with the needle because he cannot see what he is doing because the skin is not cut open. You would think the doctor would know enough how to use Xiaflex correctly or would take more time to be more careful with what he is doing just because an MD should be better than this.
I got a lawyer after being told I have permanent hand damage. I hope this story helps other people understand what can happen with Xiaflex injections. JCL

Greetings JCL,
I am sorry that this happened to you. This information will help inform people what can happen as a result of Xiaflex injections (collagenase clostridium histolytica) for Dupuytren’s contracture.
Xiaflex injections are promoted by the drug maker as being a “non-surgical option for Dupuytren treatment.” I believe this is not accurate for many reasons. Perhaps the most telling reasons are that it requires special training, and it takes a whole lot longer and costs a whole lot more to perform Xiaflex injections than what is involved with a simple shot. Anyone who has actually been through the experience knows that it is surgery. Right? It is only called a non-surgical procedure to get the patient to agree to do it. The bottom line is that you had a small hand surgery with large consequences.
Thanks for the information. Good luck to you. TRH

2. –
Dr. Herazy,
I am a 61 year old man in generally good health. I had two series of Xiaflex injections for Dupuytren’s contracture 28 and 30 months ago in my right ring finger. The first go round didn’t work because the cord would not break no matter how hard he pushed that poor little finger backward. I thought he was going to break if off so I begged him to stop. Two months later we did the whole procedure again and the cord finally popped.

After all this time the palm is still so tender that it wakes me almost every night and I had to change jobs at work to a lower paying position because I couldn’t do my old job any more. Even a light touch to the palm makes me jump, I can’t wash my face, get dressed or to grip the car steering wheel without pain. All of this seems to be because when the doctor popped the cord the end started to curl up and it immediately pushed the skin up from below the surface of the palm where the palm was smooth and normal before the Xiaflex injections. The curled up ball of cord is still there today.

To add to my misery, I saw another doctor who is a hand specialist because 4 months ago the Dupuytren’s contracture started to come back in the same spot. As the 2nd Dupuytren’s pucker grows it must press into the balled up cord and makes the pain worse. The new doctor said he doesn’t do Xiaflex injections because of bad reactions like this one. He warned me any corrective surgery to clear up this mess will be more extensive and the results will not be as good because so much tissue was either lost or weakened. I am worse off than before the Xiaflex injections and I will sue the doctor who did this to me.
Thanks for letting me vent.
Jackson

Greetings Jackson,
Before your surgery did the doctor explain what he/she was going to do and the possible outcomes? Were you told the Xiaflex injection surgery could result in a rolling up or curling of the freed end of Dupuytren’s contracture cord? Were you told that a less than perfect outcome of a Xiaflex injection was possible, or were you told you would be good as new and everything would be perfect? Did the surgeon offer to surgically remove the curled end of the cord to reduce the pressure on your palm?
As part of your legal action I hope you got a second opinion about the current state of your hand and what can be done to help you, using another surgeon located as far away from the first surgeon as possible. Unbiased evaluations and independent second opinions can suffer if doctors know each other.

Please let us know what happens next. People with Dupuytren’s contracture need to know about the range of reactions and responses, good and bad, that can arise after a Xiaflex injection surgery. TRH

3. –
What i am writing you about is to tell you I am really unhappy cuz of what happen with the ziaflex shots i got in the dupy inmy hands, the first hand turned out OK i guess because i didn’t have much pain accept the day it was done until two days later when the cords were broken up it really killed me, but then the DC came back in maybe two yrs, but the real problem was when a yr later i had the other hand done an it turned out worse the skin around the shots open up and culd not heal for a long time and i still have a lot of pain and cant move the fingers like before, the doc who did it says this happen sometime and this is ok for now, im not so sure about any of it, what do you think, ron

Greetings Ron,
There are some people who are happy after they get Xiaflex injections for Dupuytren’s contracture and there are other people who are not happy because they get bad results. Sometimes a little pain and stiffness is almost normal after any surgery, and other times the results are worse than they should be. It depends on a lot of things.

I think you should go see another, different, doctor to see what he thinks about what happened to both of your hands. Go to someone who only treats hand problems, not just an average kind of doctor. And go to someone far away from the first doctor. Tell him how you feel and how your hand and fingers move now compared to before.

It sounds like maybe something went wrong with the Xiaflex injection in the second hand surgery. I cannot say for sure to advise you because I have not examined you. Maybe something can be done for the hand pain and stiffness that you have. Ask the new doctor if you should get a lawyer.

4. –
Hello Doctor H, I had a series of Xiaflex injections for Dupuytren’s contracture of my left 4th and 5th fingers a little more than two years ago. As I was leaving the hospital I started to feel sharp pain in the left hand and wrist, and by next morning the hand pain was worse and it traveled up and into the armpit and shoulder. This left sided pain has been intense and constant ever since and often I feel numbness in the upper arm and shoulder. The doctor who did the Xiaflex injections said I have arthritis in the arm and hand from overwork, even though he never x-rayed me or examined my shoulder. He didn’t know what to say when I told him I never had arm pain in my life until the hour he did put those Xiaflex shots into my hand. I think he is trying to avoid responsibility for this problem. Do you think I should get a lawyer? Libby W.

Greetings Libby W.,
Sorry to hear of the bad time you are having with your hand and arm.
Perhaps it will make you feel a little better to know you are not the only one to have this kind of reaction of radiating pain after receiving Xiaflex injections (collagenase clostridium histolytica) for Dupuytren’s contracture.

Other people with a similar history of migrating pain and tingling from the fingers extending into the arm pit and shoulder were later told they received poorly administered Xiaflex injections for their Dupuytren’s contracture. An improperly delivered Xiaflex injection can result in it actually leaving the site of injection and migrating up the chain of lymph nodes, eventually collecting in the arm pit where many lymph nodes are normally found. If a large amount of collagenase collects in those lymph nodes it can digest tissues of the region and even destroy the shoulder joint in some cases. I once communicated with someone who received a flawed Xiaflex injection that needed an artificial shoulder joint replacement along with multiple cosmetic and corrective surgeries.

Concerning the lawyer: First things first. Tend to your health and get some help for that left arm and hand. I suggest you get a second opinion from a hand specialist who is located far from the doctor who did you Xiaflex injections. Find someone with experience treating Dupuytren’s contracture with Xiaflex and its complications, to determine the cause and correct treatment of your complaints. Later, this doctor can also guide you concerning litigation.

The outcome of any surgery is in great part determined by the skill and experience of the surgeon; more so perhaps when it comes to Dupuytren’s contracture and Xiaflex injections. Patients should take far more time and effort to determine just who it is who will operate on them. And yes, as far as I am concerned a Xiaflex injection for Dupuytren’s contracture is indeed surgery. Don’t let any doctor play down the risk and complexity of the procedure to make you think there is an easy way to correct your Dupuytren’s contracture. So pick your next doctor carefully and wisely.

If legal action is on your horizon, it is always a good idea to make detailed dated notes as soon as possible, while the information is still fresh in your mind. Make detailed notes about all conversations and encounters with the doctor who performed the Xiaflex injections, as well as everything you can recall about what happened and how you felt before and after surgery. Write down everything you can remember. Everything.
Good luck to you. TRH

5. –
Dear Dr. Herazy,
Three years ago I had a Xiaflex injection series in my left 4th finger. The injection was extremely painful but nothing like when the cords were broken the next day, I felt like my hand was going to explode. I have had three children and popping that cord was more painful than childbirth.

Over the next few days the hand began to swell and become very painful at the injection site. A few days later I could see pus and patches of dark tissue covering half of the palm. The doctor said I was having a “reaction” and would do “a small surgical procedure” to remove skin that was dying. I was afraid I was going to lose my hand. Eventually I had three surgeries over the next four months to get things under control because the parts of muscles and tendons were being destroyed as fast as the decayed tissue could be removed.

Today I have no feeling in any of the fingers, the whole hand is in constant pain and made worse by any touch, and I cannot grip anything because of pain and weakness. After I demanded straight answers my doctor finally admitted that Xiaflex must have leaked out into the hand tissue during or after he made his injections. This caused those tissues to be destroyed, or what remained of them to not heal well. He said mine was the worst Xiaflex problem he has had of those that have leaked out.

I am writing because a few weeks ago I noticed what looks like the start of another Dupuytren’s contracture again near my left pinky finger. After all I have gone through!! My DC is coming back!! I definitely will never have another Xiaflex shot for anything. I am looking for non-surgical options and want your thoughts on what I should do next. Should I get a lawyer?
Thank you,
Lucille

Greetings Lucille,
So sorry to hear of the bad problems you are having.

Xiaflex injections for Dupuytren’s contracture do not prevent recurrence – it appears to me that sometimes the speed of recurrence is faster after a Xiaflex procedure than after typical hand surgery. Perhaps this is because of the way collagenase enzyme digests the collagen fibers of living tissue, compared to being cut with a scalpel. Whatever the reason, recurrence after three years is not unusual; I hope your doctor warned you about this before you had the Xiaflex injections.
In view of your most recent experience, I suggest that you should be very cautious and conservative with the next step you take for your DC. You can still use the DCI method of Alt Med self-treatment after what you have been through, but your results will be less than if you did not have the additional scarring in your hand. Self-healing is made more complicated and slowed by all the additional scarring, heavier Dupuytren’s contracture that develops in a recurrence, secondary tissue loss and reduced blood flow that complicate healing. But for those who are desperate for some relief, even a small amount of tissue change can improve pain and increase movement significantly. You will only know if it can help you, and how much it might help you, if you try.

The body always tries to heal and self-repair to the best of its ability. That is the way nature works. With the DCI procedure you supply those nutrients and use those therapies that are intended to boost and support that natural healing process. Over the years the DCI procedure has been used by many people after Xiaflex injections and hand surgery. DCI gets 8-10 reports of moderate to marked improvement of Dupuytren’s contracture for every one report of failure. It is not perfect, it is not a cure, but it is better than doing nothing and letting it get worse.

You should talk to a trusted family member or a close friend, someone with experience dealing with lawyers, and get their opinion about seeing a lawyer.

If you have additional questions about Dupuytren’s contracture treatment after Xiaflex injections please let me know. Good luck to you. TRH