He was one of the first to use the drug in the UK, as Chief Investigator for a scientific study. He has continued to use the surgical drug in routine clinical practice, having performed over 360 injections by October 2015. He has also performed over 1000 operations for Dupuytren’s. Professor Warwick has led the training for use of this drug in the whole of Europe, as Chairman of the Xiapex Advisory Board. He is the lead author on several peer reviewed publications and book chapters. He is Editor in chief of the comprehensive European book on Dupuytren’s Disease. His own results have been presented at national and international meetings.

Read a free textbook on Dupuytren;’s disease : here

There are various treatments for Dupuytren’s Disease. Each individual patient needs to be carefully assessed to decide which treatment is most suitable. Not all patients are suitable for Xiapex ®. Mr Warwick can advise on which is the most suitable treatment for you. Options include:

Leave alone
Not all cords need treatment. The disease will not always get worse. Many people manage well.

Needle fasciotomy
A very discrete cord be ruptured by scratching it repeatedly with a needle through the skin. If the technique works, there is an eventual recurrence rate of up to 60%

There is a little evidence that this helps early disease in the palm.

Simple surgery under local anaesthetic (selective fasciectomy)
This is used for simple cords in the palm or finger, The skin is anaesthetized and a zig-zag scar is made. The nerves and blood vessels and tendons are carefully isolated and then the Dupuytren’s tissue is removed. The wound is cosed with stitches which are taken out about 10 days later. It takes 3 to 4 weeks for the hand to recover. The disease recurs in about 30 to 40% of people eventually

Complex excision (fasciectomy)
This is for more complicated cords and plaques. An arm block or general anaesthetic is needed because the surgery can take quite some time. It takes 3 to 5 weeks to recover depending on the complexity. A splint is usually required for 3 months at night. The risks are rare but include numbness and stiffness.The eventual recurrence rate is 30 to 40%

Skin grafting
This is used for very dense disease, recurrent disease or people who have got aggressive disease at a younger age. The entire involved skin is removed and then resurfaced with spare skin taken from the inner arm. This is held with dissolvable sutures and a dressing which looks like a boxing glove for 7 days. A splint is worn at night for 3 months. The rehabilitation is usually straightforeard as there is plenty of fresh skin but it takes 4 to 5 weeks to get proper function back. The advantage is that the recurrence rate is very low (less tha 8%). Risks include graft failure, numbness and stiffness.

Download David Warwick’s Chapter on Dupuytren’s Here

Collagenase (Xiapex®)
This is the new treatment that in suitable cases can replace the above.

Press Release
PDF Download Download the full article.

Contact The Hand Clinic

For more information please contact me direcly or via my PA Rachel:

0345 4505 007
Professor David Warwick
Rachel Hecks (PA)

The Hand Clinic
Nuffield Hospital
Winchester Road
Chandlers Ford
SO53 2DW


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