David Warwick is one of the leading experts in Europe on this condition. He has performed over 1000 operations on patients with Dupuytren’s disease and has performed over 350 Xiapex injections.

He is Editor of the FESSH Instructional Course Book 2015 “Dupuytren’s” Disease” and has written several papers and book chapters on the topic. He has been invited to lecture in several European countries and Australia on Dupuytren’s.

He was Chairman of the development programme for training how to use collagenase Xiapex safely in Europe and was lead Author of the Point X study which was a study of the use of Xiapex in 280 patients from several European countries.

Published papers


Pub 1

Warwick et al 2015 New insights into the immediate outcome of collagenase injections for Dupuytren’s contracture Published on Line August 2015 J Hand Surg Eur.


Pub 2

Warwick et al Collagenase Clostridium histolyticum: emerging practice in press J Plast Surgery Hand Surg


Pub 3

D. Warwick, M. Arner, G. Pajardi, B. Reichert, Z. Szabo, E. H. Masmejean, J. Fores, D. S. Chapman, R. A. Gerber, F. Huard, A. Seghouani1 and P. P. Szczypa Collagenase Clostridium histolyticum in patients with Dupuytren’s contracture: results from POINT X, an open-label study of clinical and patient-reported outcomes J Hand Surg 2015; ;40E: 124-32.


Pub 4

Arvind M, Vadher J, Ismail H, Warwick D The Southampton Dupuytren’s Scoring Scheme J Plast Surg Hand Surg. 2014 Feb;48(1):28-33


Pub 5

Warwick D, Thomas A, Bayat A. (2012) Dupuytren’s Disease: Overview of a common connective tissue disease with a focus on emerging treatment options International Journal of Rheumatology. 2012 7:309-323


Pub 6

Warwick D, Vadher J Belward P, Setty K. The Southampton Dupuytren’s Clinic:, audit of an effective multidisciplinary model. Hand Therapy 2010;15:100-104

Pub 7

Journal of Plastic Surgery and Hand Surgery

Collagenase Clostridium histolyticum: emerging practice patterns and treatment advances. April 16.




Dupuytren’s Disease FESSH 2015 Instructional Course Book 2015

I was the Editor of this book, recruiting 60 authors from across Europe to produce a state of the Art description of the topic.


Living Textbook of Hand Surgery 2015

An online text book with several authors from around the world, under the asupices of the International Federation of Societies for Surgery of the Hand to be freely available and continuously updated. I have co-ordinated and edited the chapter on Dupuytren’s Disease. I wrote the Chapter on Skin Grafting in Dupuytren’s Disease.


Dupuytren’s Disease and related Diseases- the Cutting Edge. (Ed Werker, Dias, Eaton, Reichert, Wach, Springer due 2016

  • Correlation of function with deformity in Dupuytren’s Disease -the condition specific Southampton Scoring Scheme outperforms the generic QuickDASH
  • Collagenase – what we may never know – a discussion on the limitations of the Randomized Controlled Trial

WHAT IS COLLAGENASE? Xiapex ® is the trade name of collagenase clostridium hystiolyticum which is produced naturally from a bacterium called clostridium histolyticum. Over many years the concept was developed to establish the viability of this alternative technique, then dose ranging studies and then a clinical trial programme to prove its effectiveness.  The drug specifically dissolves the collagen contained within a cord of Dupuytren’s Disease. This removes a segment of the cord. Once a segment is removed, the cord no longer tethers down the finger and so the finger can straighten.

To find out more about Xiapex click here

In 2010 it was given approval by the FDA (Federal Drugs Administration ) in the USA; in 2011 it was given approval by the European Medicines Agency and then by the UK.  The evidence which led to the approval by the FDA and European Medicines Agency can be seen below:

The surgical drug is be available at David Warwick’s Hand Clinic at the Nuffield Wessex to insured patients (subject to confirmation from their insurance carrier) and to self-funding patients. NHS treatment is not presently available but is being sought.