Dupuytren's Contracture Consult

IDENTIFYING INFORMATION:
Thank you for your referral of Edward Carter for consultation. He was examined on November-19-2025.

CLINICAL HISTORY:
Mr. Carter is an 81-year-old right-handed gentleman who presents for follow-up of Dupuytren's contracture in his right hand. He was last seen in January 2021 and underwent XIAFLEX treatment at that time. Over the past five years, he has experienced a slow recurrence of contracture, specifically affecting the right long finger and right small finger, with nodules present in these areas. He reports functional limitations primarily when shaking hands, requiring adjustments due to the contracture, but he remains able to play golf without significant difficulty. He is aware of the potential for further progression and is considering options for intervention, including needle aponeurotomy or repeat XIAFLEX treatment in the United States, as XIAFLEX is no longer available in Canada. He understands the recurrence rates associated with both needle aponeurotomy and XIAFLEX (approximately 40-50% within five years) and is open to intervention if symptoms worsen or become more functionally limiting. He also has a history of multiple fractures to the right ring finger, which he believes may independently limit its function apart from the Dupuytren's disease.

PAST MEDICAL HISTORY:
- Dupuytren's contracture, right hand (treated with XIAFLEX in 2021, recurrence noted)
- Multiple fractures to right ring finger
- Hyperlipidemia
- Gastrointestinal condition (on medication)
- Obesity (on weight loss medication)

SOCIAL HISTORY:
- Retired, plays golf actively without limitations from hand condition
- Travels to the United States seasonally
- Has travel insurance for emergencies, but no health insurance coverage for XIAFLEX in the US
- Right hand dominant

PAST SURGICAL HISTORY:
- XIAFLEX treatment for Dupuytren's contracture, right hand, 2021

ALLERGIES:
No known allergies

MEDICATIONS:
- Statin (dose/frequency not specified)
- Gastrointestinal medication (name/dose not specified)
- Weight loss medication (previously Ozempic, now a similar agent; name/dose not specified)
- No blood thinners

PHYSICAL EXAMINATION:
Examination of the right hand reveals recurrence of a cord on the right small finger, with a significant portion extending into the palm. The right long finger shows a nodule with some thickness in the palm, primarily around the PIP joint. The right ring and index fingers are unaffected. The patient is able to make a full fist, which is beneficial for playing golf, but has difficulty fully extending the affected fingers.

INVESTIGATIONS:
None

PLAN:
- Procedure Options: Discussed treatment options including observation, needle aponeurotomy (needle release), repeat XIAFLEX injection in the United States, and surgical fasciectomy.
- Placed patient on a waitlist for needle aponeurotomy (estimated wait time 3-4 months).
- Advised patient to explore XIAFLEX treatment options while in the United States and to cancel the needle aponeurotomy appointment if treated there.
- Reviewed recurrence rates for needle aponeurotomy and XIAFLEX (approximately 40-50% within five years).
- Discussed risks of infection and nerve injury (small but not zero), as well as the more significant recovery period and potential for stiffness with surgical intervention.
- Patient is aware of all options and will proceed with intervention if symptoms worsen or become more functionally limiting.

I will continue to monitor Mr. Carter’s progress and update you as needed.

Benjamin Harris, MD
Plastic Surgery
Regional Medical Center