title: Collagenase enzymatic fasciotomy for Dupuytren contracture in patients on chronic immunosuppression.
abstract: Collagenase enzymatic fasciotomy is an accepted nonsurgical treatment for disabling hand contractures caused by Dupuytren disease. We conducted a study to investigate use of collagenase in an immunosuppressed population. We retrospectively reviewed data from 2 academic hand surgical practices. Eight patients on chronic immunosuppressive therapies were treated with collagenase for digital contractures between 2010 and 2011. Thirteen collagenase enzymatic fasciotomies were performed in these 8 patients. Mean preinjection contracture was 53.0°. At mean follow-up of 6.7 months, mean magnitude of contracture improved to 12.9°. Mean metacarpophalangeal joint contracture improved from 42.0° to 4.2°. Mean proximal interphalangeal joint contracture improved from 65.8° to 21.7°. Three of the enzymatic fasciotomies were complicated by skin tears. There were no infections. As more patients seek nonsurgical treatment for Dupuytren disease, its safety and efficacy in select cohorts of patients should continue to be evaluated prospectively.
authors.affiliation: Royal Adelaide Hospital, Adelaide, South Australia, Australia. michael.waters2@health.sa.gov.au.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Waters
authors.forename: Mark R
authors.initials: MR
authors.lastname: Belsky
authors.forename: Philip E
authors.initials: PE
authors.lastname: Blazar
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Leibman
authors.forename: David E
authors.initials: DE
authors.lastname: Ruchelsman
mesh_terms: D000368:Aged; D017364:Collagenases / Q000627:therapeutic use*; D004387:Dupuytren Contracture / Q000188:drug therapy* / Q000473:pathology; D005205:Fascia / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008171:Lung Diseases / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D017364:Collagenases