Efficacy of Injectable Collagenase in the Treatment of Dupuytren's Contracture in Comparison to Partial Fasciectomy

Document Type : Original Article

Authors

The Department of Plastic Reconstructive & Maxillofacial Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Abstract

Background: Dupuytren's disease as a benign fibroproliferative
disease with an abnormal slowly progressive thickening
and shorting of the palmar aponeurosis leads to severe functional
limitations in the finger movements particularly of the
Metacarpophalangeal (MCP) joints and/or the Proximal Interphalangeal
(PIP) joints. The authors aimed to evaluate the
role of injectable collagenase (CCH) in the treatment of
Dupuytren's contracture in comparison to surgical treatment.
Material and Methods: This study included 15 patients
(33 rays), they were divided into two groups, Group A: 26
rays underwent open fasciectomy. (10 patients) and Group B:
7 rays were treated by collagenase injection. (5 patients).
Exclusion criteria for group B were contraindications of
injection of CCH. The primary efficacy variable was clinical
success, contracture correction to within 5º of normal (normal
=0º) by using goniometry. Additional efficacy variables
included the time and number of injections required to achieve
success in the primary joint. Recurrence rate and adverse
effects were recorded.
Results: Initial clinical experience was recorded of 5
patients (7 rays) (mean age 57 years) and compared to previously
surgically managed 10 patients (26 rays) (mean age 59
years). Of all population, 51% for little, 47% for ring, 1% for
middle and 1% for index fingers. The mean of the preintervention
fixed flexion contracture in the MCP joint was
39º and improved to one-year postintervention 14º, and in the
PIP joint 47º to 19º. In group B one ray with no improvement
at all and recurrence in one ray. Partial stretching was achieved
in one ray. No serious complications were observed after
injections. In cases of group A (26 rays) that was treated by
partial fasciectomy, recurrence occurred in 6 rays and nerve
injuries as nerve division and neuropraxia occurred in 2 rays.
Conclusion: The treatment of Dupuytren's disease with
injectable collagenase is safe and effective. However, the
financial aspects should be considered especially in developing

Keywords

Main Subjects

References

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