This patients photos are the next day after XIAFLEX injection equally into five dotted areas.  The thick cords were not weakened enough for rupture with manipulation under local anesthesia since the XIAFLEX was diluted into five aliquots.  Judicious needle fasciotomy in two areas (bloody) completed the straightening.  Needle and XIAFLEX can be combined, however it is more optimal to do this after much of the swelling has gone down.  In this case traveling from another state, the needle was safely done the next day to allow straightening of the finger and saving another visit.  An alternative would be to re-inject XIAFLEX in one month.

The upper left photo shows the finger before XIAFLEX injection for Dupuytren's The photo on the upper right shows the bruising seen the following day. The lower photographs are the finger at two-week followup exam, also showing great improvement after one treatment cycle.

Dupuytren's will continue to grow and develop after any treatment. However, all options for future treatment are available such as repeat XIAFLEX injections, needle aponeurotomy, or surgical excision depending on how fast the disease re-develops.

Surgical removal of diseased fascia in Dupuytren's is a traditional surgical approach.  It removes the diseased fascia entirely and may help prevent recurrence.  It may be performed as an office surgery using local anesthetia with epinephrine and no constricting tourniquet.  It's safety and efficacy has been published in the Journal of Plastic and Reconstructive Surgery in March of 2005.

This before after needle release of Dupuytrens shows the problem of weak and contracted intrinsic muscles that limit post-operative ability to regain extension.  Notice on the preoperative photo upper Dupuytrens contracture the little finger.  There is MCP and PIP joint disease that limits extension of the little finger.  Plus MCP joint disease of the ring and middle fingers that prevent full extension.  After NA, the MCP joint disease is corrected on all three fingers in the bottom left picture.  In the upper right picture the intrinsic muscles are relaxed via MCP joint forced flexion and there is improvement in PIP extension over the bottom left view.  In the final bottom right photo one can see that the dupuytrens contracture is all released and there is full PIP extension with passive extension by the physician.

These photos demonstrate the need for postoperative exercises to improve intrinsic muscle strength as these muscles have atrophied due to non-use.

On a positive note, it notice the immediate, excellent improvement of MCP extension of the little, ring, and middle fingers

This patient had two previous open surgeries by a top local hand surgeon.  With residiual contracture of 65 degrees after two surgeries, the patient was told  that nothing more could be done. 

NA after previous open surgery has higher complications and poorer results, but this before and immediate after photo shows a very good immediate result.  If recurrence is rapid due to scar tissue from the previous open surgeries, then a repeat NA with skin grafting would be the next option.