Thanks for the information Flora. On the surface it seems to confirm my thinking that an experienced hand surgeon who has performed treatments using NA and Xiaflex is going to be in a better position to judge which treatment will be safest and is likely to produce the best results for a particular patient.

Information about status 8 months after injection is not particularly helpful given the usual rate of progression. My own NA was great for the first 18 months and the contracture gradually returned over the past 48 months years to the point where I am seeking additional treatment.

It is not true that Xiaflex is just like NA. With NA the incisions go along the chord and with Xiaflex there is a single point of injection of a substance that does not travel much through the tissue. The Xiaflex dissolves tissue and this can include tendons and ligaments which is not the case with NA.

Lidocaine was viewed initially as a panacea and injected into many people's hands to relieve a variety of conditions including trigger finger. It was discovered to lead frequently to ruptured tendons and sometimes the permanent crippling of individuals. I see a parallel to Xiaflex as a treatment for Dupuytren's and only time, a lot of time, will tell.

flojo:

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Moondanc,

My understanding is that Dr. Denkler uses the vial at one time, but does multiple injections of small amounts. He did say the if a whole vial were put in one spot and a tendon was too close, it potentially could compromise the tendon. He sees small amounts in several places along the cord minimizing the likelihood of messing up a tendon and also breaking the cord at several places will likely keep the cords severed. When he did NA for me, he did more than one snap of a cord. (I really didn't want to know everything he was doing at the time)

I know Dr. Denkler knows hands. I also know he prefers to do NA and now Xiaflex when possible, but if not, he still does surgery for on hands that NA or Xiaflex isn't a viable treatment.

Edited 02/16/11 02:12

bstenman:

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The Xiaflex dissolves tissue and this can include tendons and ligaments which is not the case with NA.

Quote: The Xiaflex dissolves tissue and this can include tendons and ligaments which is not the case with NA.

To be fair, there are similar risks and complications with NA. Tendons and nerves can be cut with NA. The actual risk of severe complications with either NA or Xiaflex is low. With an experience doctor doing NA or injecting Xiaflex your risk of serious complications should be very low.

The most important issue in my opinion is what best in your situation. What is best for your hands, your disease progress, your financial/insurance situation, your proximity to medical care, etc.

As far as effectiveness I think they are similar in regard to correction of bent fingers and recurrence.

David26:

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To be fair, there are similar risks and complications with NA. Tendons and nerves can be cut with NA. The actual risk of severe complications with either NA or Xiaflex is low. With an experience doctor doing NA or injecting Xiaflex your risk of serious complications should be very low.

As far as effectiveness I think they are similar in regard to correction of bent fingers and recurrence.