Clinical Results of Collagenase Treatment for Dupuytren’s Disease: A Case Series Study With 2-Years Follow-Up

Basso, Morena Anna; Bernasconi, Alessio; Balato, Giovanni; Cozzolino, Andrea; Famiglietti, G.; Smeraglia, Francesco

doi:10.1590/1413-785220233101e259218

Cited by 5 publications

(7 citation statements)

References 19 publications

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“…Compared with the enzymatic treatment, our approach, although more complex and invasive, reported a low recurrence rate and none of the complications associated with the collagenase. [29][30][31] Conversely, no major adverse events were reported in our study population.…”

Section: Discussionmentioning

confidence: 58%

Dupuytren's Disease: A Novel Minimally Invasive Pull-Through Technique

Maruccia,

Tedeschi,

Sisto

et al. 2024

Arch Plast Surg

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Background Dupuytren's disease decreases quality of life significantly and often requires surgical treatment, nevertheless there is no actual gold standard. The aim of this study was to introduce the use of minimally invasive pull-through technique. Methods From 2016 to 2020, 52 patients suffering from Dupuytren's contracture were treated with the minimally invasive pull-through technique. We evaluated the improvement in range of motion, pain, disability, and quality of life in the long term. Total extension deficit, quick disabilities of the arm, shoulder, and hand (QuickDASH), and EuroQol five dimensions—five levels index were systematically scored before each surgical intervention and reevaluated after 24 months. Results Fourteen patients (26.9%) had already received a previous intervention (percutaneous needle aponeurotomy or collagenase Clostridium histolyticum). The mean preoperative total active extension deficit was 84.0 ± 23.3 degrees (55–130 degrees). Mean follow-up was 36 months. There were no cases of tendon rupture or neurovascular injury. Total active extension deficit at the final follow-up was 3.4 ± 2.3 degrees (0–12 degrees). The mean active range of motion of the MCP and PIP joints were, respectively, 90.5 ± 3.3 degrees (85–96 degrees) and 82.7 ± 2.5 degrees (80–87 degrees). At 24 months after cord excision, a mean 10.7 points improvement in the QuickDASH questionnaire was registered (p < 0.001). Pull-through technique was equally effective both on patients with a primary or a recurrent disease. Eight patients (15.4%) had a recurrence of disease in the metacarpophalangeal joint or proximal interphalangeal joint. Conclusion The pull-through technique is a simple, accessible, and effective technique for the treatment of Dupuytren's contracture. The use of palmar mini-incisions combined with minimal dissection has a low risk of iatrogenic injury to the neurovascular bundles and tendons, and has a low risk of recurrence rate. This study reflects level of evidence IV.

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Section: Discussionmentioning

confidence: 58%

Dupuytren's Disease: A Novel Minimally Invasive Pull-Through Technique

Maruccia,

Tedeschi,

Sisto

et al. 2024

Arch Plast Surg

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“…Nevertheless, their uses are different and of extreme effectiveness in the wound fields [ 44 , 50 , 52 ]. Recently, its use has also been expanded to Dupuytren’s disease, after the withdrawal of Clostridium hystolyticum collagenase from the European Union for commercial reasons [ 67 , 68 ]. Animal model studies have demonstrated that collagenase from Vibrio alginolyticus does not cause skin necrosis, and no skin tears or wound dehiscences were observed, demonstrating the safety of this novel collagenase.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Study of a Novel Vibrio alginolyticus-Based Collagenase for Future Medical Application

Sierra

Biswas

Busato

et al. 2023

Cells

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Mesenchymal stem cells extracted from adipose tissue are particularly promising given the ease of harvest by standard liposuction and reduced donor site morbidity. This study proposes a novel enzymatic method for isolating stem cells using Vibrio alginolyticus collagenase, obtaining a high-quality product in a reduced time. Initially, the enzyme concentration and incubation time were studied by comparing cellular yield, proliferation, and clonogenic capacities. The optimized protocol was phenotypically characterized, and its ability to differentiate in the mesodermal lineages was evaluated. Subsequently, that protocol was compared with two Clostridium histolyticum-based collagenases, and other tests for cellular integrity were performed to evaluate the enzyme’s effect on expanded cells. The best results showed that using a concentration of 3.6 mg/mL Vibrio alginolyticus collagenase allows extracting stem cells from adipose tissue after 20 min of enzymatic reaction like those obtained with Clostridium histolyticum-based collagenases after 45 min. Moreover, the extracted cells with Vibrio alginolyticus collagenase presented the phenotypic characteristics of stem cells that remain after culture conditions. Finally, it was seen that Vibrio alginolyticus collagenase does not reduce the vitality of expanded cells as Clostridium histolyticum-based collagenase does. These findings suggest that Vibrio alginolyticus collagenase has great potential in regenerative medicine, given its degradation selectivity by protecting vital structures for tissue restructuration.

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“…Among them, 14 publications met the inclusion criteria, as depicted in Figure 1, representing a total of 967 patients with an average follow-up of 19.22 (1-84.06) months. Of these 14 studies [26][27][28][29][30][31][32][33][34][35][36][37][38][39], six pertained to CCH injection [26,[35][36][37][38][39], two to LF [33,34], and six directly compared these two treatment modalities [27][28][29][30][31][32], as summarized in Table 1.…”

Section: An Overview Of the Reviewed Studies' Characteristicsmentioning

confidence: 99%

“…Among the six CCH injection studies, five were prospective cohort studies [26,35,[37][38][39], while one was an RCT [36]. The two LF studies comprised both an RCT [34] and prospective cohort studies [33].…”

Section: Complications Of Cch Versus Lf In Comparative Studiesmentioning

confidence: 99%

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Comparing Complications and Patient Satisfaction Following Injectable Collagenase Versus Limited Fasciectomy for Dupuytren’s Disease: A Systematic Review and Meta-Analysis

Alhebshi,

Bamuqabel,

Alqurain

et al. 2024

Cureus

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Dupuytren's disease (DD) is a fibroproliferative disorder that manifests as an abnormal growth of myofibroblasts, causing nodule formation and contractures and affecting digit function. If left untreated, these contractures can lead to a loss of mobility and potentially impact hand function. This systematic review critically compares and evaluates the existing literature on the complications and patient satisfaction following injectable collagenase Clostridium histolyticum (CCH) versus limited fasciectomy (LF) for DD. We performed a comprehensive search of the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), The Cochrane Library, and Excerpta Medica database (EMBASE) databases from 2006 to August 2023. This research targeted all clinical studies involving adults who underwent injectable collagenase and/or limited fasciectomy in the management of DD. Out of the 437 identified studies, only 53 were considered eligible for our analysis, and merely 14 met our inclusion criteria. These selected studies encompassed a total of 967 patients with 1,344 treated joints, with an average follow-up duration of 19.22 (ranging from one to 84.06) months. Within this cohort, 498 joints from 385 patients underwent LF, while 846 joints from 491 patients received CCH injections. Notably, among the 491 patients treated with CCH, 1,060 complications were reported, averaging 2.15 complications per patient, with the most common being contusion/bruising/hematoma/ecchymosis (22.54%), and edema/swelling (18.96%). In contrast, among the 385 patients treated with LF, only 97 complications were reported, translating to 0.25 complications per patient, with the most frequent being paraesthesia or numbness (23.7%), scar sequelae like skin laceration, tear, fissure, or hypertrophic scar (23.7%), and neuropraxia or nerve injury (22.6%). Our meta-analysis indicates that paraesthesia or numbness is more frequently observed in LF than CCH injections, although without statistical significance, with a risk ratio (RR) of 0.39 (95% confidence interval (CI) 0.13-1.18, p-value 0.1). However, scar sequelae (hypertrophic scar, skin laceration, tear, or fissure) show a contrasting pattern, being more commonly associated with CCH injections than LF, with an RR of 1.98 (95% CI 0.26-14.85, p-value 0.51), which, upon eliminating the source of heterogeneity, becomes statistically significant, with an RR of 4.98 (95% CI 1.40-17.72, p-value 0.01). Our data revealed a higher frequency of complications with CCH compared to LF, although more severe adverse effects were observed in the LF group, such as neuropraxia or nerve injury. Scar sequelae were more common with CCH injections. Despite both treatments showing increased patient satisfaction at the final follow-up, CCH injection resulted in earlier improvements in satisfaction.

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Clinical Results of Collagenase Treatment for Dupuytren’s Disease: A Case Series Study With 2-Years Follow-Up

Cited by 5 publications

References 19 publications

Dupuytren's Disease: A Novel Minimally Invasive Pull-Through Technique

Dupuytren's Disease: A Novel Minimally Invasive Pull-Through Technique

In Vitro Study of a Novel Vibrio alginolyticus-Based Collagenase for Future Medical Application

Comparing Complications and Patient Satisfaction Following Injectable Collagenase Versus Limited Fasciectomy for Dupuytren’s Disease: A Systematic Review and Meta-Analysis

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