This patients photos are the next day after XIAFLEX injection equally into five dotted areas.  The thick cords were not weakened enough for rupture with manipulation under local anesthesia since the XIAFLEX was diluted into five aliquots.  Judicious needle fasciotomy in two areas (bloody) completed the straightening.  Needle and XIAFLEX can be combined, however it is more optimal to do this after much of the swelling has gone down.  In this case traveling from another state, the needle was safely done the next day to allow straightening of the finger and saving another visit.  An alternative would be to re-inject XIAFLEX in one month.