Reviewed on : 16 May 2019

Reviewed by : Rob Fontaine Coventry and Rugby Clinical Commissioning Group (CCG)

Expires : 16 May 2021

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 via RSS using the appropriate Prior Approval Referral Form.

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.

An intervention (collagenase injections*, needle fasciotomy, fasciectomy and dermofasciectomy) should be considered for:

• Finger contractures causing loss of finger extension of 30° or more at the metacarpophalangeal joint or 20° at the proximal interphalangeal joint.

OR

• Severe thumb contractures which interfere with function

NICE concluded that collagenase should ONLY be used for:

• Participants in the ongoing clinical trial (HTA-15/102/04)

OR

• Adult patients with a palpable cord if there is evidence of moderate disease (functional problems and metacarpophalangeal joint contracture of 30° to 60° and proximal interphalangeal 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

*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.