Reviewed on : 9 Sep 2021

Reviewed by : Lucy Dyde Coventry & Warwickshire CCG IFR and Gateway Editor

Expires : 9 Sep 2023

Dupuytren’s Disease Surgery is a Low Priority Procedure.

Prior approval from the Clinical Commissioning Group will be required before any treatment proceeds in secondary care.

The following criteria should be used to establish if the condition is mild, moderate or severe:

Classification:

Mild

• No functional problems
• No contracture
• Mild metacarpo-phalangeal joint contracture only (<30 deg)

Moderate

• Notable functional problems
• or Moderate metacarpo-phalangeal joint contracture (30-60 deg)
• or Moderate proximal inter-phalangeal joint contracture (<30deg).
• First web contracture

Severe

• Severe contracture of both metacarpo-phalangeal (>60 deg) joint and proximal inter-phalangeal joint (>30 deg).

TREATMENT RECOMMENDATIONS

Prior approval from the CCG will be required before any treatment proceeds in secondary care. 

Refer to Secondary Care provider using the appropriate Prior Approval Referral Form.

DUPUYTREN’S DISEASE IN ADULTS SURGERY/  COLLAGENASE CLOSTRIDIUM HISTOLYTICUM INJECTION (XIAPEX®)

Eligibility Criteria

Treatment is not indicated in cases where there is no contracture, and in patients with a mild (less than 20°) contractures, or one which is not progressing and does not impair function.

Collagenase Clostridium Histolyticum (Xiapex®) 

The CCG approves the prescribing of Collagenase Clostridium Histolyticum injection (Xiapex®), by HAND SURGEONS only, in an outpatient setting, for the treatment of Dupuytrens contracture with a palpable cord in adults in accordance with NICE TA459.

NICE TA459 (26 July 2017) recommends that people who meet the inclusion criteria for the ongoing clinical trial (HTA 15/102/04), comparing Collagenase Clostridium Histolyticum (CCH) to limited fasciectomy, are encouraged to participate in the study.

DUPUYTREN’S REFERRAL CRITERIA

Please confirm that the patient meets the criteria for ONE of the following sections:

Section a (surgery)

The patient’s finger contracture is causing a loss of finger extension of 30° or more at the metacarpophalangeal joint or 20° at the proximal interphalangeal joint.

Section b (surgery)

The patient has severe thumb contractures which interfere with function

Section c (Collagenase)

The patient will be participating in the ongoing clinical trial (HTA-15/102/04) for treatment with Collagenase

Section d (Collagenase)

The patient is over 18 years of age and has a palpable cord and there is evidence of moderate disease (functional problems and meta-carpophalangeal joint contracture of 30° to 60° and proximal inter-phalangeal joint contracture of less than 30° or first web contracture) plus up to two affected joints

AND

Needle fasciotomy is not considered appropriate, but limited fasciectomy is considered appropriate by the treating hand surgeon