Hand surgery · London
Xiapex & needle fasciotomy for Dupuytren’s contracture - London.
A clinic-based, local-anaesthetic alternative to open surgery. A consultant hand surgeon divides the fibrous cord with a fine needle in 15 to 30 minutes, the finger straightens on the table, and you are back at a desk within a few days.
Why patients choose us
- 01
A named hand surgeon, not a generic orthopaedic list
A consultant hand surgeon running a dedicated Dupuytren’s programme in a high-volume London hand unit, comfortable with needle fasciotomy, limited fasciectomy and revision work.
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The right procedure, honestly discussed
PNF for the right cord, open surgery for the right disease. We do not sell either to you - we explain why one fits your hand and the other does not.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
What Dupuytren’s contracture is
A progressive palmar fibromatosis that quietly bends the fingers.
The palmar fascia thickens into nodules and cords, most commonly along the ring and little finger rays, and slowly pulls the digits into flexion. It is painless but functionally limiting - the tabletop test becomes positive and everyday tasks get awkward.
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The condition itself
A hereditary connective-tissue disorder with strong Northern European and Scandinavian heritage links. Men over 50 are affected more often, and there are frequent family patterns. Diabetes, alcohol and smoking are recognised associations.
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What patients notice
A firm lump in the palm at the base of the ring or little finger, then a cord that becomes visible on stretching the hand. The finger starts to sit slightly bent. Washing the face, putting a hand in a pocket and shaking hands become the giveaway moments.
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When to act
A positive tabletop test - the hand no longer sits flat on a table - is the classical trigger. MCP contracture under 30 to 45 degrees is ideal for PNF; PIP contracture, thick skin involvement, or recurrence usually points to surgery.
Non-surgical options
Two names, one procedure standing today.
Historically UK patients had two non-surgical routes: Xiapex collagenase injection and percutaneous needle fasciotomy. Xiapex has not been available in the UK or EU since 2020, which leaves PNF as the modern non-surgical choice.
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Xiapex (collagenase clostridium histolyticum) - historical context
Xiapex was a bacterial collagenase injected directly into the Dupuytren’s cord. Over 24 to 48 hours it dissolved the cord chemically, followed by a manipulation session to snap it. Sohonos-style branding aside, it was widely used in the UK from around 2011.
In 2020 the manufacturer withdrew Xiapex from the UK and EU market for commercial reasons - not safety - and it has not been replaced. UK patients now considering a “Xiapex injection” are effectively asking about PNF.
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Percutaneous needle fasciotomy - the current non-surgical choice
PNF, also called percutaneous needle aponeurotomy, uses a fine needle under local anaesthetic to divide the cord mechanically. The technique dates back to French rheumatology practice in the 1970s and has a growing UK evidence base.
It is clinic-based, takes 15 to 30 minutes, needs no anaesthetist, and gives immediate correction on the table. The trade-off is a higher recurrence rate than open surgery - offset by how easily it can be repeated.
Indicative pricing
What private needle fasciotomy costs in London.
Indicative ranges across our London hand-unit partners. Send photos of the hand and we quote firm figures across two or three options.
In short
Needle fasciotomy in our London network: £1,800–£3,200 per digit, all-in including consultation, procedure, splinting and follow-up.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultant hand surgeon consultation | £250–£450 | 30–45 min | Same visit |
| Percutaneous needle fasciotomy - single digit | £1,800–£3,200 | 15–30 min | Same visit |
| Percutaneous needle fasciotomy - two digits, same session | £3,000–£4,800 | 30–45 min | Same visit |
| Hand therapy package (splinting, 3 sessions) | £350–£600 | 45 min each | Weekly |
| Open limited fasciectomy - single ray (comparator) | £6,500–£11,000 | 60–90 min | Day case |
| Second-opinion review of prior hand surgery | £250–£450 | 30 min | 48 hours |
Prices vary by unit, by which hand surgeon runs the case, and by how many digits are treated in one session. Hand therapy is usually a separate package. We come back with a firm quote within one working day.
The journey
From referral to straightened finger - what happens, in order.
One team from first message to final review - including the consultation, the procedure, hand therapy and long-term surveillance for recurrence.
- 01
Before
You send us photos of the hand
A short confidential form with photos of the hand flat on a table, the tabletop test, and any prior operative notes.
- 02
Before
We come back with a recommendation
Within one working day: whether PNF, collagenase (historical) or open fasciectomy fits, and how many digits are realistic in one sitting.
- 03
Before
Clinic consultation and marking
The surgeon confirms the cord is palpable and discrete, marks the puncture points, and consents you. Bloods and clotting reviewed.
- 04
On the day
Arrival at the clinic
A local anaesthetic block to the affected digit and palm. No sedation needed for most cases. You stay awake and comfortable.
- 05
On the day
Percutaneous needle fasciotomy
15 to 30 minutes. A fine needle divides the fibrous cord at multiple levels under the skin, then the finger is extended and the cord audibly snaps.
- 06
On the day
Splint, dressing, home
A light dressing and a night extension splint. Home within the hour. Someone can drive you though most patients drive themselves.
- 07
After
Hand therapy and follow-up
Hand therapy from day one, night splint for one week, review at two weeks. Surveillance annually for recurrence at the same or adjacent ray.
Who it is for - and who needs surgery
When PNF is the right step - and when open fasciectomy is safer.
The Dupuytren’s pictures that lead to a needle - and the ones where an open limited fasciectomy or dermofasciectomy is the more durable answer.
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Early Dupuytren’s with a discrete cord
A palpable, well-defined pretendinous cord in the palm - the ideal target for a needle, without diffuse nodularity fixing the skin.
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MCP joint contracture under 30 to 45 degrees
Contracture confined to the metacarpophalangeal joint corrects predictably with PNF - MCP disease is the strongest indication.
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Ring or little finger involvement
The classic Dupuytren’s pattern. Ulnar-sided rays with a straight cord along the digit are the everyday PNF case.
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Patients who need to be back at work fast
Office work within 1 to 3 days and manual work within 1 to 2 weeks - a decisive advantage over open fasciectomy.
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Elderly or medically unfit for open surgery
PNF is a clinic procedure under local. It suits patients on anticoagulants, with cardiac comorbidity, or where a general anaesthetic is best avoided.
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Patient preference for minimally invasive
A tiny puncture heals in two weeks with no scar. Some patients simply prefer this over an open incision, even accepting the higher recurrence rate.
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PIP joint contracture beyond 40 degrees
Proximal interphalangeal joint disease corrects less reliably with a needle - open limited fasciectomy usually gives a more durable result.
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Recurrent or diffuse disease with skin involvement
Multiple prior recurrences, extensive palmar involvement, or skin tethered to the cord - open fasciectomy or dermofasciectomy is the safer call.
Procedure options
The full family of Dupuytren’s procedures - non-surgical to open.
What each option actually involves. PNF as the modern non-surgical choice, open fasciectomy as the durable comparator, and the historical Xiapex option kept in the picture for context.
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Percutaneous needle fasciotomy (PNF)
A fine needle divides the cord at multiple levels under the skin, under local anaesthetic. Clinic-based, 15 to 30 minutes, immediate correction, quick recovery. The workhorse non-surgical option.
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Xiapex collagenase (historical only)
A collagenase injection that dissolved the cord over 24 to 48 hours, followed by manipulation. Withdrawn from the UK and EU market by the manufacturer in 2020 for commercial reasons - no longer available in the UK.
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Open limited fasciectomy
Excision of the diseased cord through a zigzag or Bruner incision. Day-case general or regional anaesthesia. 90%+ correction, 30 to 40% recurrence at 5 years, 6 to 12 week recovery.
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Dermofasciectomy with skin graft
Excision of cord and overlying skin, replaced by a full-thickness skin graft. Reserved for diffuse or recurrent disease where the skin itself is involved. Lowest recurrence rate.
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Segmental fasciectomy
Removal of a short segment of cord through a small incision. A middle ground between PNF and full fasciectomy, chosen occasionally for intermediate disease.
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Repeat PNF for recurrence
PNF is easily repeated. Because it leaves no scar, a recurrent cord can be needled again years later - often the reason patients pick PNF first, knowing they can convert to surgery if needed.
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Hand therapy and splinting
Immediate mobilisation with a night extension splint for one week, then hand-therapist-led exercises. Splinting alone does not treat Dupuytren’s but supports every procedure.
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Second-opinion review
A specialist review of your hand, photos and any prior operative notes - sometimes the answer is a different procedure, or watchful waiting until the tabletop test is positive.
Where it is done in London
A small panel of hand specialists, we picked them.
Consultant hand surgeons at The London Orthopaedic Clinic, The Hand Clinic, Cromwell Bupa Hand Unit, HCA Wellington, King Edward VII, London Bridge Hospital Hand Surgery and Chelsea and Westminster Private. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every hand surgeon in our London network.
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Consultant hand surgeons on the BSSH specialist register with a dedicated Dupuytren’s practice
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High-volume London hand units with same-day hand therapy on site
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Facilities for open limited fasciectomy and dermofasciectomy if the needle route is not right
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Clear escalation pathway to revision surgery for recurrence years later
Outcomes, recovery and vs surgery
What to expect afterwards - honestly.
Immediate contracture correction above 70% is standard, with a complication rate under 3%. Recurrence at 5 years sits at 50 to 70% - higher than surgery but easily re-treated. Small skin tears heal in two weeks.
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Local anaesthetic only
A digital and palmar block. No sedation, no fasting, no anaesthetist. Patients on anticoagulants can usually proceed without stopping them - reviewed case by case.
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Skin tear in 5 to 10%
A small skin split at the puncture site is the commonest complication. It heals by itself in 1 to 2 weeks with a light dressing - no stitches needed.
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Nerve injury under 1%
Transient numbness along a digital nerve occurs in under 1% and recovers over weeks. Permanent nerve division is rare in experienced hands.
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Tendon injury very rare
The needle stays superficial to the flexor sheath. Tendon injury is exceptional when the anatomy is respected and the cord is truly palpable.
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Splint at night for one week
A custom night extension splint for the first week, then as needed. Daytime splinting is not required and interferes with hand therapy.
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Hand therapy from day one
Gentle range-of-motion exercises begin the same day. Full-time hand therapy input for 2 to 4 weeks gives the best functional result.
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Back to office work in 1 to 3 days
Typing and light desk work resume within a few days. Manual work, heavy gripping and contact sports at 1 to 2 weeks once the skin is healed.
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Recurrence at 5 years: 50 to 70%
Higher than open surgery, and the number patients most want to know. The trade-off is faster recovery, no scar, and the ability to repeat PNF easily.
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Red flags after discharge
Loss of sensation in the finger tip, a cold or dusky digit, spreading redness or fever - call the unit the same day.
Percutaneous needle fasciotomy
Faster, repeatable, less durable.
- · 15 to 30 minutes, clinic-based, local anaesthetic.
- · Correction over 70% at MCP joint; less at PIP.
- · Office work in 1 to 3 days, manual work in 1 to 2 weeks.
- · 5-year recurrence 50 to 70%, easily repeated.
- · Complication rate under 3%; small skin tears commonest.
Open limited fasciectomy
Slower, scarred, more durable.
- · 60 to 90 minutes, day case, general or regional anaesthetic.
- · Correction 90%+, works well for PIP as well as MCP.
- · Recovery 6 to 12 weeks with hand therapy throughout.
- · 5-year recurrence 30 to 40%.
- · Wound complications in 5 to 10% - infection, delayed healing, stiff scar.
Reading your operative note
Your PNF note in four parts. Read the last one first.
Whichever unit does the procedure, the operative note the hand surgeon sends afterwards keeps to the same shape.
A quiet reminder
Contracture angles are precise numbers - we translate them into what you will actually notice.
If you would like us to talk you through the note before your hand therapy review, just ask.
- 01 Header
Digits treated and pre-op contracture angles
Which rays were needled, and the MCP and PIP contracture angles in degrees before the procedure - the baseline to judge correction against.
- 02 Technique
Puncture levels and anaesthetic used
Number and location of needle passes, whether the palm alone or palm plus digit was addressed, and the local anaesthetic block used.
- 03 Findings
Post-correction extension and any skin tears
Passive extension achieved on the table, any skin split that occurred, and whether a full or partial correction was obtained.
- 04 Impression
Splint plan and hand therapy schedule
Read this first: night splint duration, hand therapy start date, review appointment, and when to expect the next assessment if recurrence begins.
Recognised by major UK insurers
Cover for needle fasciotomy is usually funded when there is a functional deficit and a specialist referral - we confirm cover before booking.
Frequently asked
Everything we get asked about needle fasciotomy.
Quick answers on recurrence, insurance, repeat treatment, multiple digits, sensation and the surgical option.
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What is the recurrence rate after needle fasciotomy?
Around 50 to 70% at 5 years, compared with 30 to 40% after open limited fasciectomy. The trade-off is deliberate: PNF gives a much faster recovery and no scar, and it can be repeated easily. Many patients pick PNF first, knowing they can convert to open surgery later if needed.
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Will private medical insurance cover needle fasciotomy?
Most major UK insurers - Bupa, AXA Health, Vitality, Aviva, WPA, Cigna - cover PNF when there is a functional deficit (positive tabletop test, MCP contracture, or difficulty with daily tasks) and a specialist referral. Cover for early cosmetic disease is less consistent. We confirm authorisation with your insurer before booking.
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Can PNF be repeated if the cord comes back?
Yes, and this is one of its main advantages. Because there is no scar, a recurrent cord in the same digit can be needled again years later. Most patients get several years of straightened function from each PNF session, and the option of open fasciectomy remains open if disease becomes diffuse.
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Can multiple digits be treated in the same session?
Yes. Two adjacent digits with palpable cords are commonly treated together in a 30 to 45 minute session. Three or more is possible but usually staged, both to keep the local anaesthetic dose within safe limits and to allow hand therapy to focus on one area at a time.
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Will I lose sensation in the finger?
Transient numbness along the treated digital nerve occurs in under 1% of cases and usually recovers over weeks to months. Permanent sensory loss is rare when the procedure is performed by a hand surgeon who knows the local anatomy. The risk is higher in revision cases and where prior surgery has distorted the tissue planes.
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If PNF fails, can I still have open surgery?
Yes. PNF does not burn any bridges. If the correction is incomplete, if the cord recurs quickly, or if PIP disease progresses, open limited fasciectomy remains fully available. Many hand surgeons see PNF and open fasciectomy as complementary rather than competing, staged over years as the disease evolves.
Ready to start
Send us photos of the hand - we come back within a working day.
Palm flat on a table, the tabletop test, and a photo of the finger from the side. We match you to a consultant hand surgeon in a London hand unit and quote a firm figure across two or three options.