Collagenase treatment of Dupuytren’s contracture using a modified injection method

Abstract

Background and purpose Treatment of Dupuytren’s contracture (DC) with collagenase Clostridium histolyticum (CCH) consists of injection followed by finger manipulation. We used a modified method, injecting a higher dose than recommended on the label into several parts of the cord, which allows treatment of multiple joint contractures in 1 session and may increase efficacy. We studied the occurrence of skin tears and short-term outcome with this procedure.Patients and methods We studied 164 consecutive hands with DC, palpable cord, and extension deficit of ≥ 20º in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint (mean patient age 70 years, 82% men). A hand surgeon injected all the content of 1 CCH vial (approximately 0.80 mg) into multiple spots in the cord and performed finger extension under local anesthesia after 1 or 2 days. A nurse recorded skin tears on a diagram and conducted a standard telephone follow-up within 4 weeks. A hand therapist measured joint contracture before injection and at a median of 23 (IQR: 7–34) days after finger extension.Results A skin tear occurred in 66 hands (40%). The largest diameter of the tear was ≤ 5 mm in 30 hands and > 10 mm in 14 hands. Hands with skin tear had greater mean pretreatment MCP extension deficit than those without tear: 59º (SD 26) as opposed to 32º (SD 23). Skin tear occurred in 21 of 24 hands with MCP contracture of ≥ 75º. All tears healed with open-wound treatment. No infections occurred. Mean improvement in total (MCP + PIP) extension deficit was 55º (SD 28).Interpretation Skin tears occurred in 40% of hands treated with collagenase injections, but only a fifth of them were larger than 1 cm. Tears were more likely in hands with severe MCP joint contracture. All tears healed without complications. Short-term contracture reduction was good.

Collagenase injections for Dupuytren disease: 3-year treatment outcomes and predictors of recurrence in 89 hands

“…A hand surgeon injected collagenase into the cord using a modified method (Atroshi et al. 2015). After reconstituting collagenase with 0.39 mL of diluent, the surgeon injected all reconstituted collagenase (approximately 0.80 mg) in the cord, distributed in multiple spots along the palpable cord, from the PIP joint to the palmar crease.…”

“…Skin tears after the manipulation procedure were treated with simple dressing and nurse follow-ups, as described previously (Atroshi et al. 2015). The patients returned to the hand therapist after 1 week for splint adjustment.…”

“…2015) and injecting a higher dose (Atroshi et al. 2015, Grandizio et al. 2017) has been shown to be safe and effective.…”

Surgical fasciectomy versus collagenase injection in treating recurrent Dupuytren disease: study protocol of a randomised controlled trial

“… 18 A previous study has shown that patients treated with collagenase injection for recurrence after surgical fasciectomy had a mean improvement of 43° (SD 28) in total extension deficit. 39 To be able to show a difference of at least 20° in total extension deficit between the groups at 3 months with a SD of 25, alpha level of 0.05 and statistical power of 80%, a sample size of 50 patients (25 per group) will be needed. We aim to recruit 56 patients to account for any potential loss to follow-up.…”

Dupuytren and Collagenase: Are they really as Simple as they Seem?

“…In the treatment of Dupuytren's disease (DD), the use of Collagenase Clostridium Histolyticum (CCH) represents a new therapeutic alternative for this condition which currently has no definitive cure. Since the publication of the study by Hurst et al [1] in which the immediate clinical results were very positive, several studies have validated the efficacy of CCH using different drug administration protocols with the same safety values [2][3][4][5]. Clinical results appear promising, with recurrence rates similar to those after surgery [6].…”