This is a summary of the NHS Devon CCG commissioning policy for Dupuytren's contracture treatment
Supporting referral guidelines
Western: Dupuytren's clinical referral guideline
Treatment is not commissioned in cases where there is no contracture, and in patients with mild (less than 20°) contractures, or one which is not progressing and does not impair function.
Refer to Hand Clinic
Medical treatment of Dupuytren's contracture with collagenase injections (Xiapex®) is commissioned in accordance with NICE technology appraisal TA459:
In adults with a palpable cord only if all of the following apply:
- 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 2 affected joints.
- Percutaneous needle fasciotomy (PNF) is not considered appropriate, but limited fasciectomy is considered appropriate by the treating hand surgeon.
- The choice of treatment (CCH or limited fasciectomy) is made on an individual basis after discussion between the responsible hand surgeon and the patient about the risks and benefits of the treatments available.
- One injection is given per treatment session by a hand surgeon in an outpatient setting.
Surgical intervention (needle fasciotomy, fasciectomy and dermofasciectomy) is commissioned for:
- a) Finger contractures causing loss of finger extension of 30° or more at the metacarpophalangeal joint or 20° at the proximal interphalangeal joint
- b) Severe thumb contractures which interfere with function
(For further information see link to the NHS Devon Dupuytren's Contracture Treatment commissioning policy)
Exceptional /Individual Funding Requests (IFR)
Dupuytren's contracture treatment
- First line
- Second line