title: Skin graft loss resulting from collagenase clostridium histolyticum treatment of Dupuytren contracture: case report and review of the literature.
abstract: Treatment of Dupuytren disease with collagenase clostridium histolyticum is increasingly used among hand surgeons. Although it is generally safe and efficacious, complications related to enzymatic fasciotomy occur. Postapproval surveillance and communication among hand surgeons continues to refine the indications, contraindications, and complications recognized in the treatment of Dupuytren disease with enzymatic therapy. Major treatment-related adverse events previously reported include flexor tendon rupture and complex regional pain syndrome. We report a patient who experienced total loss of a well-established volar ring finger skin graft following collagenase injection and propose a potential mechanism of vulnerability. This case may illustrate the susceptibility of type I collagen, which is uniformly present in a healed skin graft bed, to degradation with collagenase. We propose a cautious approach when considering treatment of a Dupuytren cord with collagenase in the presence of an overlying skin graft, regardless of the age of the graft.
authors: Division of Plastic Surgery, University of Washington School of Medicine, Seattle, WA 98195, USA. swanson2@uw.edu
authors: Jordan W
authors: JW
authors: Swanson
authors: Andrew J
authors: AJ
authors: Watt
authors: Nicholas B
authors: NB
authors: Vedder
mesh_terms: D001864:Bone Wires; D047009:Hathewaya histolytica / Q000201:enzymology*; D004387:Dupuytren Contracture / Q000175:diagnosis / Q000188:drug therapy*; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D003012:Microbial Collagenase / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003012:Microbial Collagenase