Before:

After:

John Livingston suffers from Dupuytren’s disease, a hand deformity that affects the tissues in his palm and causes his fingers to be bent. His case is unusual in that both hands are affected, including the thumb and index fingers. The disease makes fine motor skills, writing and gripping a glass challenging. After watching his mother and older brother suffer from the disease, the retired lawyer quickly came to a diagnosis while in his mid-50s. Doctors don’t know what causes Dupuytren’s (pronounced du-pwe-TRANZ), but it is a genetic disorder most common in people of Northern European descent and in men over age 50. Livingston is from Ireland.

Early on, the disease begins as a thickening of the skin on the palm. While it can be sensitive to the touch, it usually isn’t painful. As the disease progresses, excessive collagen builds up, forming thick, rope-like cords of tissue that prevent the fingers from being able to relax and straighten completely. Prior to his referral to the Hand Center at the Seton Institute of Reconstructive and Plastic Surgery, 67-year-old Livingston had undergone three surgeries – two on the left hand to improve his ring finger and a third on the right hand to straighten three fingers. In April 2009, his physician, Dr. Sanjay K. Sharma, performed surgery on his left hand and achieved positive results straightening the thumb and index finger.

In addition to surgery, Sharma now employs Xiaflex, a new enzyme injection. Approved by the Food and Drug Administration in early 2010 as the first nonsurgical treatment for Dupuytren’s disease, the injected drug causes an enzymatic breakdown of the excessive build-up of collagen in the hand and essentially melts the cords. “After the enzyme melts the cord, it is possible to manipulate the joints to break the cord and straighten the fingers,” Sharma said. “Both the injection and manipulation are done during an office visit under local anesthesia. This approach allows a more rapid return to normal activity without the rehabilitation required following surgery.”

Sharma injected the new enzyme in Livingston’s right hand in December with extraordinary results. Twenty-four hours after the injection, Livingston returned to the Hand Center. After administering Lidocaine to numb Livingston’s hand and nerves, Sharma did a combination of massaging and stretching his fingers and his palm. “I heard a large crack that sounded like a chicken bone breaking,” Livingston said. “Then a second similar crack and finally, a small pop that sounded like bubble packaging material popping. The only aftereffects were some tenderness and bruising. I didn’t require any pain medication.”

Having experienced both surgery and the injection, Livingston is impressed by the new treatment. Recovery from his most intense surgery required up to six months of hand therapy physical therapy focused on the function of his hands along with difficult wound care for his incisions.

A 2009 study published in the New England Journal of Medicine showed that 64 percent of all joints and 76.7 percent of metacarpophalangeal joints, or knuckles, achieved full extension and normal or near-normal straightening of the treated finger 30 days after the last injection. Longer-term results are unclear, but for now, this treatment is helping patients avoid surgery and getting them back to a lifestyle they enjoy.

Livingston, excused from the task of addressing holiday cards, was satisfied to be capable of retrieving Christmas decorations from the attic and surprised to be able to grip a rake so soon after the procedure. “I would not hesitate to do this again,” he added. “I saw excellent progress the very next day. There was mild swelling after the injection, but it was a much quicker recovery. I’m just shocked by the overnight improvement.”

A keen specialist for all problems related to the upper extremities, Sharma brings a unique perspective to hand surgery with his combined training in plastic surgery and orthopedic surgery. He currently serves as the director of Hand Surgery Services at the University Medical Center Brackenridge and Dell Children’s Medical Center of Central Texas. Sharma and his partner, Dr. Steven Henry, see almost 5,000 patients each year. In addition to Dupuytren’s disease management, the Hand Center offers many advanced surgical procedures to help restore form and function to hands, wrists and forearms harmed by trauma or disease, and to correct anomalies from birth. Hand Center physicians treat common hand conditions and injuries such as rheumatoid arthritis and osteoarthritis, trigger fingers, carpal tunnel syndrome, hand/wrist fractures and wrist sprains and dislocations.

The Seton Institute of Reconstructive and Plastic Surgery is part of the Seton Family of Hospitals, the leading provider of health care services in Central Texas and a growing center for medical research and innovation. The physicians are on-call at the area’s only Level I Trauma Centers for adult and pediatric patients – University Medical Center Brackenridge and Dell Children’s Medical Center of Central Texas – and also have privileges at other locations across the Seton Family.

The only plastic surgery practice of its kind in Central Texas, the institute offers five unique subspecialty centers under one roof:

• Breast Center
• Craniofacial Center
• Hand Center
• Plastic Surgery Center
• Wound Care Center

The team is comprised of seven highly skilled plastic and reconstructive surgeons, four mid-level providers and more than 15 staff members. The group works with all insurance plans and workers’ compensation claims, and helps patients understand their coverage.

For more information about the Seton Institute of Reconstructive and Plastic Surgery, call 512-324-8320 or 877-977-3866 (toll-free). You may also visit www.setonplasticsurgery.com.

Locations:

Clinical Education Center at Brackenridge
1400 North I-35, Ste. 320
Austin, Texas 78701

Seton Family of Doctors
5103 Kyle Center Drive, Ste. 104
Kyle, Texas 78640

Seton Williamson Medical Plaza I
301 Seton Parkway, Ste. 402
Round Rock, Texas 78665