Melbourne Hand Surgery 

COVID news: Elective surgery restrictions have been lifted and we will resume all elective surgeries from 28 September. Please note that all patients who are scheduled for elective surgery admission are required to undertake a COVID test, to obtain a negative ("not infected") result prior to admission, and to self-isolate from the time of test to admission. 

All suitable consultations at Melbourne Hand Surgery are currently conducted via telehealth (phone or video consultation) to maximise patient and staff safety. We have implemented enhanced hygiene meaures in our rooms including acrylic screens, masks, hand sanitiser, face shields and physical distancing-related changes. We are closed on Fridays.

Victorians are in this together and together we will get through this. Thank you for your understanding as our community works through these unprecedented times together (last updated: 16 September 2020).

Important update on Injectable Collagenase: Injectable Collagenase is no longer listed on the Australian Register of Therapeutic Goods. While there are remaining vials of medication in Australia, and we understand that these are viable until April 2021, if you are to have collagenase treatment we must seek prospective approval for the injections from the Department of Health via the Special Access Scheme. The status of collagenase treatment in Dupuytren's disease can be discussed with Dr Tomlinson in a consultation, should you wish to do so. 

An injection option for Dupuytren's contracture has been developed in the last decade, using an enzyme to digest collagen build up in the hand. In this treatment an enzyme ("clostridium collagenase", brand name "Xiaflex®") is injected directly into the tough cords in the hand. The enzyme digests collagen at the site of the injections, and 1-7 days later patients return to their doctor for a strenous hand stretch. The aim of this stretch is to rupture the weakened cord, straightening the hand. Collagenase treatment can have complications (as can surgery, and needle fasciotomy).

The likelihood of major local complications from collagenase treatment is reduced if your doctor injects the correct amount of the enzyme precisely into the areas that need to be treated. Dr Tomlinson's significant experience with needle fasciotomy for the treatment of Dupuytren's contracture means that she is well versed in assessing the thickness and depth of Dupuytren's cords, and can also advise you if she feels that needle fasciotomy would be a better non-surgical treatment option for your hand. Dr Tomlinson is also able to combine collagenase treatment with needle fasciotomy, which can improve the effectiveness of treatment, particularly in individuals who have multiple areas of the hands involved or involvement of the finger joints.

Information about Xiaflex® is available at the HealthDirect website. The medication costs $1437.70 for us to purchase one vial of the collagenase product and this cost is passed directly on to our patients. Some private health insurers offer a rebate on the cost of the medication, depending on the details of your policy, but the majority do not. Xiaflex® is not listed on the Pharmaceutical Benefits Scheme, so there is no government subsidy for its use. An application for a PBS listing was turned down in July 2013.

How do I know if this treatment is the right one for me?

If you would like to be assessed for your suitability for clostridium collagenase treatment and to discuss the process of treatment and recovery, please contact us to arrange an initial consultation with Dr Tomlinson. 

Your initial appointment

At your initial consultation you will be assessed by Dr Tomlinson and she will advise you whether you are suitable for non-surgical treatment, which the majority of patients are. She will then outline the Dupuytren's contracture treatment options with you (surgery, needle fasciotomy and injectable collagenase) and discuss your desired outcomes and recovery timeframes.

If you and Dr Tomlinson determine that injectable collagenase treatment is the desired treatment option you will be provided with and Dr Tomlinson will discuss with you our information pack which contains:

1. Flow chart regarding the process of treatment with injectable collagenase (reproduced below)
2. Patient consent form for injectable collagenase treatment
3. Brochure(s) regarding injectable collagenase treatment
4. Patient instructions for after initial injections (first stage)
5. Patient instructions for after manipulation (second stage)
6. Two letters regarding injectable collagenase treatment that you can use to explore the option of rebates on this medical treatment with your private health insurer if you wish to do so. 

Our administrative staff will provide you with a written fee estimate and financial consent for your treatment by Dr Tomlinson, and will discuss the available treatment dates and times with you. If you wish to schedule dates and times for your injectable collagenase treatment our administrative staff can assist you with this on the day of your appointment, or in subsequent days or weeks via email or phone. Our administrative staff will also liaise with your preferred hand therapist regarding your initial post treatment hand therapy appointment. If you do not have a preferred hand therapist it is our experience that the hand therapy group Action Rehab that is on site at 549 Bridge Road is a convenient option for our patients.

If you have questions or queries regarding your private health insurance coverage for injectable collagenase and for post treatment hand therapy please contact your private health insurer to discuss what coverage, if any, your insurer provides. If you do not have private health insurance but are interested in obtaining Medicare rebates on 5 allied health visits (which can include hand therapy) through Medicare please schedule an appointment with your general practitioner to discuss whether you are eligible for a Chronic Disease Management Plan.

Both the first and second stage treatments are administered at 549 Bridge Road Richmond by Dr Tomlinson, with local anaesthetic administered to the hand. 

If you require more than one treatment on the same hand, which is unusual, this would be spaced a minimum of 4 weeks apart. If you wish to have both hands treated we recommend spacing these treatments at least 3 months apart, due to the inconvenience of splinting both hands at night. 



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