title: Treatment of dupuytren disease with injectable collagenase in a veteran population: a case series at the department of veterans affairs new jersey health care system.
abstract: BACKGROUND
  Clinical trials seeking to establish long-term efficacy of injectable collagenase clostridium histolyticum for treatment of Dupuytren disease are ongoing. In this quality improvement study, the efficacy, recurrence rate, and complications of collagenase injection for Dupuytren disease are reviewed in a population of Veteran patients.
  
  
  METHODS
  A retrospective chart review was performed for patients who underwent treatment with injectable collagenase for Dupuytren disease from 2010 to 2013 at our regional Department of Veterans Affairs medical center. Data points of interest included the degree of joint contracture preoperatively, immediately after treatment, and at follow-up, complications, and patient satisfaction.
  
  
  RESULTS
  Sixteen patients received 27 injections (18 metacarpophalangeal and 9 proximal interphalangeal injections). The mean time of follow-up was 12.3 months. There was a 50% or greater reduction of the original extension deficit in 74.1% (n = 27) of the joints treated. Metacarpophalangeal joint recurrence was "high" (≥50°) in 0% (n = 18) of joints, and "low" (5°-50°) in 33.3% (n = 18) of joints with a mean follow-up of 12 months. Proximal interphalangeal joint recurrence was "high" (≥40°) in 18.5% (n = 9) of joints and "low" (5°-40°) in 7.4% (n = 9) of joints with a mean follow-up of 12.9 months. Minor complications were experienced in 93.8% (n = 16) of patients who underwent collagenase injection and included ecchymosis, skin laceration, injection-site swelling, injection-site hemorrhage, tenderness, and pruritus. Seventy-five percent (n = 12) of patients in our study reported they would undergo treatment with collagenase again.
  
  
  CONCLUSIONS
  The case series presented demonstrates that injectable collagenase clostridium histolyticum produced a clinical success rate of 74.1% and is a safe method to treat Dupuytren disease.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ.
authors.forename: Aditya
authors.initials: A
authors.lastname: Sood
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Therattil
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ.
authors.forename: Angie M
authors.initials: AM
authors.lastname: Paik
authors.affiliation: Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ.
authors.forename: Mary F
authors.initials: MF
authors.lastname: Simpson
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ ; Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Lee
keywords: Dupuytren disease; Xiaflex; collagenase; flexion contracture; palmar aponeurosis
references.citation: N Engl J Med. 2009 Sep 3;361(10):968-79
references.pmid: 19726771
references.citation: Hand Clin. 1999 Feb;15(1):53-62, vi
references.pmid: 10050242
references.citation: Rev Rhum Engl Ed. 1996 Jun;63(6):435-43
references.pmid: 8817754
references.citation: Plast Reconstr Surg. 1996 Mar;97(3):560-6; discussion 567
references.pmid: 8596787
references.citation: J Bone Joint Surg Br. 1997 Mar;79(2):206-10
references.pmid: 9119843
references.citation: J Hand Surg Am. 2010 Dec;35(12):2027-38.e1
references.pmid: 21134613
references.citation: J Hand Surg Br. 2005 Dec;30(6):557-62
references.pmid: 16168532
references.citation: J Hand Surg Am. 2013 Jan;38(1):12-22
references.pmid: 23200951
references.citation: PLoS One. 2012;7(2):e31430
references.pmid: 22384021
references.citation: J Hand Surg Br. 2004 Oct;29(5):423-6
references.pmid: 15336742
references.citation: Hand Clin. 1999 Feb;15(1):97-107, vii
references.pmid: 10050246
references.citation: J Hand Surg Am. 2006 Nov;31(9):1527-34
references.pmid: 17095386
references.citation: Plast Reconstr Surg. 2007 Sep;120(3):44e-54e
references.pmid: 17700106
references.citation: J Hand Surg Am. 2002 May;27(3):385-90
references.pmid: 12015711
references.citation: J Bone Joint Surg Am. 1981 Jun;63(5):787-97
references.pmid: 7240301
references.citation: J Hand Surg Br. 1999 Aug;24(4):456-9
references.pmid: 10473157
references.citation: J Hand Surg Am. 1991 Sep;16(5):775-9
references.pmid: 1834729
references.citation: Eplasty. 2010 Jan 27;10:e15
references.pmid: 20204055
references.citation: J Hand Surg Am. 1983 May;8(3):235-43
references.pmid: 6683733
references.citation: J Hand Surg Am. 2006 May-Jun;31(5):717-25
references.pmid: 16713831
references.citation: Hand Clin. 1991 Nov;7(4):635-42; discussion 643
references.pmid: 1769986
references.citation: J Hand Surg Am. 2011 May;36(5):936-42
references.pmid: 21527148
references.citation: Ann R Coll Surg Engl. 2006 Jan;88(1):3-8
references.pmid: 16460628
references.citation: Hand. 1971 Mar;3(1):38-40
references.pmid: 5098337