title: Collagenase treatment of Dupuytren's contracture using a modified injection method: a prospective cohort study of skin tears in 164 hands, including short-term outcome.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedics, Hässleholm, Kristianstad, and Ystad Hospitals , Hässleholm ;
authors.forename: Isam
authors.initials: I
authors.lastname: Atroshi
authors.forename: Jesper
authors.initials: J
authors.lastname: Nordenskjöld
authors.forename: Anna
authors.initials: A
authors.lastname: Lauritzson
authors.forename: Eva
authors.initials: E
authors.lastname: Ahlgren
authors.forename: Johanna
authors.initials: J
authors.lastname: Waldau
authors.forename: Markus
authors.initials: M
authors.lastname: Waldén
mesh_terms: D000368:Aged; D047009:Hathewaya histolytica / Q000201:enzymology*; D015331:Cohort Studies; D017364:Collagenases / Q000008:administration & dosage* / Q000627:therapeutic use*; D004387:Dupuytren Contracture / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005384:Finger Joint / Q000187:drug effects / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007267:Injections / Q000009:adverse effects / Q000379:methods*; D007407:Interviews as Topic; D008297:Male; D008662:Metacarpophalangeal Joint / Q000187:drug effects / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012867:Skin / Q000293:injuries; D016896:Treatment Outcome
chemical_list: D017364:Collagenases