Any advice for other fingers after a bad Xiaflex procedure for the first finger?

I just had the Xiaflex procedure done on my pinky finger and it was an extremely painful procedure I must say. The way it was done was that on the first day the doctor injected the Xiaflex at the base of my pinky finger. Within two hours the entire area was extremely swollen and painful. The following day the doctor did what he called “the manipulation” part of the procedure. I had the already extremely swollen and tender area of my pinky shot up with lidocaine injections which was very painful in and of itself. Then the doctor started wrenching the pinky back and forth so forcefully that I about passed out. He reluctantly injected more lidocaine (on my request) and came back 30 minutes later. He again wrenched the pinky so hard back and forth that I almost passed out, and had to sit with my head between my legs to keep from passing out when he was done. As a result of wrenching my pinky so hard I developed a large blood blister at the base of my pinky, which was extremely painful and took almost two weeks to finally go away. The area is still peeling skin and rather swollen and dark pink. Is this a typical procedure for Xiaflex? What I mean is it typical for this “manipulation” of an already tender and swollen finger? I am not feeling like I do not want to go through this again on other fingers which are crooked. Please advise!



A few thoughts come to mind based on what you related about your experience with the Xiaflex procedure for Dupuytren’s contracture:

1.  What your doctor called “the manipulation” is a standard part of the usual Xiaflex injection procedure in which the Dupuytren cord is manually broken or snapped in half after it has first been weakened by injection of the collagenase enzymes in Xiaflex.  It is how the procedure is done.  First the cord is weakened and the next day it is broken by forcefully bending and extending the involved finger.

2.  Based upon what you have described, I get the impression that the doctor who did your injection did not do a good job of injecting the enzyme into the cord to weaken it.  Either he did not inject enough of the enzyme into the cord, or he missed the target tissue.  Usually the procedure is not as abusive or painful as what you have described.

3.   Based on what you have described, I get the impression that your doctor did not adequately explain ahead of time what he was going to do or what you would experience.  This is unfortunate.  Without this information you could not make an informed decision about the procedure.

4.  I wonder if you are aware that after going through the painful and prolonged Xiaflex procedure that it is just a matter of time before your Dupuytren’s contracture will recur in that same finger.  Please read my post, “Do Xiaflex injections really have a low recurrence rate?”   In this post you can read about the Dupuytren finger contracture coming back over a period of time.   Based on the way you were not told about what might happen during the Xiaflex procedure I hope you were at least told that that the Dupuytren’s contracture will always come back after any surgical intervention, and yes, a Xiaflex injection is a surgical intervention.  If your doctor says it is not, ask him for a few bottles of Xiaflex to take home because you want to inject some Xiaflex in a neighbor’s hand.  Of course, he will not give any to you because you would be doing surgery and he cannot be a part of that.       

5.  I wonder how much experience your doctor had doing Xiaflex injections?

6.  I suggest that you spend some time on the DCI website to investigate the possibility of  using Alternative Medicine for a few months to see if you can support and increase your ability to remove the Dupuytren contracture material in a more conservative manner.   There is no easy way to get rid of Dupuytren’s contracture, as you have already seen after using the “miracle” procedure with Xiaflex.  Yes, it might get rid of the Dupuytren cord without surgery, but it has the potential for serious side effects and the benefits are only temporary.  I suggest you look into trying to rid yourself of the lumps and cords in your hands without risky surgery.  TRH

What do you think about my palm that split open after Xiaflex injections for Dupytren contracture?

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.



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





Do Xiaflex injections carry a risk of reduced finger flexion?

I have read after the Xiaflex injection to surgically treat Dupuytren’s contracture that moderate pressure is applied to ‘break’ the cord. Isn’t the cord a thickened tendon? In which case is there a risk of impaired flexion? Just wondered how precise is this breakage and if it would be possible to mistakenly break the tendon altogether. I would be very grateful if you could clarify this for me.

Yours sincerely

L. Al-Nufoury (med student)


Greetings L.,

The Dupuytren’s cord is not a tendon.  It is composed of tendon-like material and tissue elements, but it is not a normal or per-existing tendon of the hand.  Is a new structure that develops on top of the tendon, it is not normal for the hand and it is shorter than normal and so causes the affected finger to be flexed toward the palm.

This Dupuytren cord will break where  it is weakened by the fibrinolytic enzymes at the site of the Xiaflex injection.  Sometimes little and sometimes great force is needed to break the cord, depending on the size of the cord and the skill of the surgeon.

A significant limitation of this procedure is that the recurrence of another tendon developing again can be rather fast; Xiaflex injections have a faster rate of Dupuytren recurrence than open or closed surgery options.  For this reason the individual will have to be exposed to additional Xiaflex injections at a later time.  Another problem is that Xiaflex injections can lead to accidental and permanent damage to nearby muscles, tendons, nerves and blood vessels. 

The real risk of impaired finger flexion arises as a result of repeated Xiaflex procedures, when no more can be done since there is a limit to the number of times these injections can be delivered into the same area.    TRH

Is the DCI treatment for Dupuytren contracture a lifetime correction?

i saw a dr. yesterday.   he wants to use the needle procedure xiaflex.  after reading DCI information on your website i’m not sure which way to go.  if i use the alternative method is it a lifetime treatment?

Good question. 

At this time we have been working with people for only 10 years using Alternative Medicine treatment of Dupuytren contracture.  During that time DCI has helped many hundreds of people from around the world improve and overcome their hand contracture problem.  And during that time I have not had anyone come back later to say their Dupuytren contracture returned – no one .    This either means that people have had their DC come back but they have not told me about it, or it means that their DC has not returned.  I cannot say for certainty which it is because we are not capable of doing follow up studies at this time of those people who report improvement of their hand problem.

Injection with Xiaflex to treat Dupuytrens is not perfect; there are inherent risks and problems that occur.  While the rate of Dupuytren recurrence after Xiaflex injections is less than after surgery, the hand problem does recur.   The makers of Xiaflex hold this finding up to indicate that this means the recurrence rate is low.  I think the Xiaflex rate of Dupuytren recurrence is not actually low; it is just not as high as after surgery.   Because these injections only make temporary changes to the hand at the specific site of drug action, you will eventually have to do the Xiaflex injections again and again.  Actually what they are finding out is that the rate of recurrence of Dupuytren contracture after Xiaflex injections will increase each time you have the injections.  This means that the more you use Xiaflex for your hand, the faster it will come back.   Each time you use Xiaflex you expose yourself to the risk of accidents and drug reactions in which blood vessels, tendons, nerves, and muscles can be permanently damaged.  For more information please read, “What is Xiaflex and what are the risks if I take it?” and “Do Xiaflex injections really have a low recurrence rate?

I cannot tell you what you should do.  But I can tell you that you should spend some time learning the pros and cons of this new procedure and fully understand what it is all about.  As a suggestion, you should consider trying a brief therapeutic trial of Alternative Medicine treatment, perhaps for a month or two,  such as you see on the DCI website to see if you can respond favorably to conservative care.  If it helps you as it has helped many others, you might not have to consider any drug or surgical treatment.  If it does not help you, you can go into a drug or surgical treatment knowing that you have tried to be conservative first and now you are ready for more radical treatment.   TRH