Xiaflex Technique

James Verheyden MD Hand and Upper Extremity Orthopedic Specialist

My Day Job

  • Dr. James Verheyden has a very busy and successful practice at The Center as a Hand & Upper Extremity Surgeon. "I have a passion for what I do and I have no intentions of slowing down my surgical practice".

  • Many things that I do in my surgical practice are very cutting edge. For example, I have given approximately 1% of all the Xiaflex collagenase injections in the entire country for hands with Dupuytren’s contracture using an off label, not FDA approved SIMple technique that can be done in the office, does not require surgery, and is much less expensive than surgery or the standard Xiaflex injection technique. After Dupuytren surgery, most patients require extensive hand therapy. It is unusual for me to refer a patient to hand therapy after a Xiaflex collagenase injection. I have performed over 1000 of these injections and this technique has proven safe and has generated wonderful results. People have travelled from Alaska, Hawaii, Georgia, and New York, and have travelled from more than 15 states because of my reputation and professionalism to have me perform these injections in the office and avoid surgery. Across the county, at the end of 2016, 75% of Dupuytren’s contracture patients were getting surgical treatment and only 25% were getting the Xiaflex collagenase enzyme treatment, and of those, only a very small number are getting the cutting edge treatment and injection technique that Dr. Verheyden provides. In Dr. Verheyden’s opinion, surgery does not need to be performed for Dupuytren’s contracture anymore. The resultant health care savings that this Xiaflex technique provides, compared to typical surgical treatment are enormous. A bottle of Xiaflex collagenase enzyme is very expensive, about $4000/bottle and this is only supposed to be injected into a single Dupuytren cord. 

    Dr. Verheyden uses the entire bottle of enzyme and cannot justify throwing out approximately $1500 worth of enzyme. He also flush out the bottle to obtain every last bit of enzyme from that bottle. Dr. Verheyden injects on average 2.5 separate Dupuytren cords per bottle of enzyme and 90-95% of patients are achieving complete contracture correction for all 2.5 separate Dupuytren cords with this one bottle of Xiaflex collagenase enzyme. Initial CORD studies demonstrated that 1.7 bottles of enzyme were required to release each individual Dupuytren cord. Dr. Verheyden’s SIMple technique saves the patient and the insurance company tremendous money while expediting patient’s care (normally each injection can only be repeated once a month) and avoiding all the negatives of surgery. The downside is that Dr. Verheyden’s injection technique frequently takes several minutes to 10-15 minutes to perform, in contract to frequently a few seconds for most physicians who are performing these Xiaflex collagenase injections. The extra time required for this SIMple injection technique, with the same physician charge by Dr. Verheyden per Dupuytren cord injected, results in significantly statistically greater results. Dupuytren’s is a disease, and recurrence data shows an approximate 50% recurrence of Dupuytren contracture 5 years after either surgery or treatment with the Xiaflex collagenase injection. One of the beautiful things with the enzyme treatment is that if the Dupuytren’s contracture comes back, it is easy to inject again with the Xiaflex collagenase enzyme. In contrast, if the Dupuytren’s contracture comes back after surgery, it is frequently very difficult to operate a second or third time. Xiaflex collagenase enzyme and Dr. Verheyden’s SIMple injection technique have revolutionized the treatment for Dupuytrens contractures.

    • Dr. James Verheyden JHS article and SIMple technique - Link

    • Dr. James Verheyden Dupuytren’s Bend Bulletin article - Link

    • The Center Website and Dr. James Verheyden - Link