New insights into the immediate outcome of collagenase injections for Dupuytren's contracture

作者：Warwick D J^*; Graham D; Worsley P

来源：Journal of Hand Surgery-European Volume, 2016, 41(6): 583-588.

DOI：10.1177/1753193415600670

• Dupuytren's disease
• collagenase
• outcome
• complications

Collagenase clostridium histolyticum is now established as an effective and safe option to treat patients with a single joint affected with Dupuytren's contracture. We have extended its use to natatory and combined cords. In a prospective consecutive series of 298 cords in 237 patients, the mean total extension loss improved in cords crossing the metacarpophalangeal joint from 46 degrees to 1 degrees, in cords crossing the proximal interphalangeal joint from 56 degrees to 7 degrees, in natatory cords from 130 degrees to 25 degrees and in combined cords from 102 degrees to 16 degrees. The immediate correction of combined cords and natatory cords was less reliable than that obtained in cords crossing the metacarpophalangeal joint or proximal interphalangeal joint. Less severe pre-intervention contractures tended to correct better. We found a high complication rate, which may cause alarm. A total of 21% developed skin splits, with the risk of skin splits generally increasing with more severe pre-injection deformity. Blood blisters were only encountered after manipulation of the more severe contractures. A total of 23 patients (8%) had a spontaneous rupture and 57 patients (19%) had a partial spontaneous rupture. Only 4.9% needed a second injection. We noticed a learning curve, with seven of the first 20 cords (35%) needing a second injection to achieve a satisfactory correction and then only seven (2.5%) in the rest. Level of evidence: IV

• 出版日期2016-7