Two days after injection with Xiaflex for my Dupuytrens contracture, during the attempted release of the pinky and ring fingers on my right hand, the skin of the palm of my hand under those fingers split open, leaving a rather deep hole approximately 1.5″ square +/-.   I have been told it happened because of previous surgery some 40 years prior.  I have been told a skin graft might be advisable if the hole does not heal quickly on its own.

Your input would be appreciated.

Greetings,

Sorry to hear of the complication from Xiaflex hand surgery.   Your situation of the palm skin splitting open is not uncommon; it happens with some frequency although doctors tend not to discuss or warn patients about this complication.  I suspect this information is kept from patients so they will not refuse Xiaflex hand surgery.  

We both know I am not involved in the treatment of your hand and have no direct knowledge of your past or current condition.  I only know the very limited things about your Dupuytren surgery with Xiaflex injections you mentioned here.   Because of this limited information I can only ask questions:

1.   Was the doctor who did your Xiaflex injections aware you had prior hand surgery 40 years ago,  before he injected you with Xiaflex?

2.  Did you deliberately or intentionally hide this information about your previous hand surgery from the doctor, or did the doctor not ask you about the past hand surgery?  In other words, was the doctor aware of your hand surgery 40 years previously, or not, before the Xiaflex injection series was done?

3.   Since I assume you either told this doctor about the prior hand surgery, or hand scars were visible and there was no need to tell the doctor, did the doctor warn you ahead of time that this complication or adverse reaction might occur?  Was this possible complication mentioned to you, explained in detail, and were you allowed to give informed consent to refuse or accept hand surgery with this information from the doctor?   In other words,  did the doctor talk to you in detail about the potential for this kind of problem to occur so that you knew what you were getting into and had the chance to accept or refuse hand surgery?

4.   Did the doctor explain to you that there was a chance for the Xiaflex injection to leak out from the Dupuytren cord and migrate up to the skin of the palm, causing the skin to deteriorate and burst open?

5.   If the doctor knew, or should have known, about the potential problem of injecting your hand with Xiaflex since you had prior hand surgery, what did that doctor do differently while injecting your hand with Xiaflex to prevent this complication in your case?  

6.  Did the doctor who made the Xiaflex injection that resulted in your palm splitting open, explain to you how a surgery that was done 40 years ago was able to interfere with the Xiaflex injection procedure?  In other words, if your hand tissue was stable for 40 years, what was the underlying problem that caused the Xiaflex injection to go so terribly wrong?

7.  What is the possibility the doctor who provided your Xiaflex injections simply made a mistake – as is common and easy to do during this Xiaflex injection procedure – to cause this  tissue injury and subsequent spitting to occur?  What is the possibility the doctor who provided your Xiaflex injections is simply trying to protect himself/herself from possible litigation by blaming someone or something else for this problem?

There are many cases in which these problems arise after Xiaflex injections or other types of hand surgery.  They are usually played down because this information is not good for the Xiaflex manufacturer or the doctors who do the work in the office.   I think if patients knew of the high rate of these problems – and worse– occurring, they would far less willing to allow this procedure to be done.  In my opinion it is best to avoid Xiaflex injections if at all possible by using the Alternative Medicine procedures discussed on this website.   The body can possibly reverse the Dupuytren tissue when given the opportunity. You will only know if you try.

I suggest you do all you can to increase your ability to heal and repair the skin of your palm.  Your medical doctor will not know much about this topic.  He will not explain that he has never studied or considered this topic, he will only say it cannot be done.   I suggest you contact someone who is experienced and trained in health management like a naturopath or a medical doctor who specializes in natural medicine.   TRH