International Orthopaedics

, Volume 42, Issue 4, pp 859–866 | Cite as

Factors influencing recurrence and progression of Dupuytren’s disease treated by Collagenase Clostridium histolitycum

  • Clarisa Simón-Pérez
  • Julian Alía-Ortega
  • Belen García-Medrano
  • Jose Ignacio Rodríguez-Mateos
  • Maria Brotat-Rodríguez
  • Hector Aguado-Hernandez
  • Miguel Angel Martín-Ferrero
Original Paper
  • 97 Downloads

Abstract

Aim of the study

The purpose of this study was to determine the recurrence rate, possible adverse reactions and factors influencing recurrence and progression of Dupuytren’s disease (DD) treated with Collagenase from Clostridium histolyticum (CCH).

Method

This was a prospective study of 71 patients with DD treated with CCH from 2011 to February 2013, with a minimum follow-up period of four years. Clinical, functional, patient satisfaction, drug safety and factors influencing recurrence and disease progression were evaluated.

Results

In all patients, the rupture of the cord was achieved after the injection, reducing joint contracture. In five patients (7%) we verified the existence of disease recurrence during the follow-up. In 11 patients (15.5%) there was a disease progression. Three patients have been surgically operated on, without added surgery difficulty; the rate of recurrence and progression was higher in grades III and IV of Tubiana, in proximal interphalangeal (PIP) punctures, and was earlier in patients younger than 60 years.

Discussion

No serious local complications or general complications were observed with this method. The recurrence of DD, following criteria of Felici, is mainly observed in young patients with greater severity of the disease and at the PIP level. Progression is influenced by the same factors. Patients operated on after recurrence have no added difficulty in the surgical technique, as it has also been published in other studies.

Conclusions

Patients with the lowest rates of recurrence and progression were those with a single cord in the metacarpophalangeal (MCP), a grade II of Tubiana, and were older than 60 years.

Keywords

Collagenase Clostridium histolitycum Dupuytren’s disease Recurrence and progression 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Peimer CA, Blazar P, Coleman S et al (2013) Dupuytren contracture recurrence following treatment with Collagenase clostridium histolyticum (CORDLESS study): 3-year data. J Hand Surg 38A(1):12–22CrossRefGoogle Scholar
  2. 2.
    Werker PM, Pess GM, Van Rijssen AL, Denkler K (2012) Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment: the importance of clear definitions. J Hand Surg 37A(10):2095–2105CrossRefGoogle Scholar
  3. 3.
    Kan HJ, Verrijp FW, Huisstede BM, Hovius SE, van Nieuwenhoven CA, Selles RW (2013) The consequences of different definitions for recurrence of Dupuytren’s disease. J Plast Reconstr Aesthet Surg 66(1):95–103CrossRefPubMedGoogle Scholar
  4. 4.
    Felici N, Marcoccio I, Giunta R et al (2014) Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence. Handchir Mikrochir Plast Chir 46(6):350–354CrossRefPubMedGoogle Scholar
  5. 5.
    Watt AJ, Curtin CM, Hentz VR (2010) Collagenase injection as nonsurgical treatment of Dupuytren's disease: 8-year follow-up. J Hand Surg 35 A(4):534–539CrossRefGoogle Scholar
  6. 6.
    Witthaut J, Jones G, Skrepnik N, Kushner H, Houston A, Lindau TR (2013) Efficacy and safety of collagenase clostridyum histolyticum injection for dupuytren contracture: short-term results from 2 open-label studies. J Hand Surg 38 A(1):2–11CrossRefGoogle Scholar
  7. 7.
    Gilpin D, Coleman S, Hall S, Houstoun A, Karrasch J, Jones N (2010) Injectable collagenase clostridium histolyticum: a new nonsurgical treatment for Dupuytren’s disease. J Hand Surg 35A(12):2027–2038CrossRefGoogle Scholar
  8. 8.
    Martín-Ferrero MA, Simón-Pérez C, Rodriguez-Mateos JI, García-Medrano B, Hernández-Ramajo R, Brotat-García M (2013) Treatment of Dupuytren’s disease using collagenase clostridium hystolyticum. Rev Esp Cir Ortop Traumatol 57(6):398–402PubMedGoogle Scholar
  9. 9.
    Desai SS, Hentz VR (2011) The treatment of Dupuytren disease. J Hand Surg 36 A(5):936–942CrossRefGoogle Scholar
  10. 10.
    Bainbridge C, Gerber RA, Szczypa PP et al (2012) Efficacy of collagenase in patients who did and did not have previous hand surgery for Dupuytren's contracture. J Plast Surg Hand Surg 46(3–4):177–183CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Swanson JW, Watt AJ, Vedder NB (2013) Skin graft loss resulting from collagenase clostridium Histolyticum treatment of Dupuytren contracture: case report and review of the literature. J Hand Surg 38A(3):548–551CrossRefGoogle Scholar
  12. 12.
    Zhang AY, Curtin CM, Hentz VR (2011) Flexor tendon rupture after collagenase injection for Dupuytren contracture: case report. J Hand Surg 36 A(8):1323–1325CrossRefGoogle Scholar
  13. 13.
    Hallock CG (2012) Skin laceration as a serious adverse sequela of injectable collagenase fordupuytren contracture. Plast Reconst Surg 129(1):205e–206eCrossRefPubMedGoogle Scholar
  14. 14.
    Chen NC, Shauver MJ, Chung KC (2011) Cost-effectiveness of open partial fasciectomy, needle aponeurotomy and collagenase injection for Dupuytren contracture. J Hand Surg 36 A(11):1826–1834CrossRefGoogle Scholar
  15. 15.
    Perez-Giner RA, Aguilella L (2015) Resultado precoz del tratamiento de la enfermedad de Dupuytren mediante inyección de colagenasa. Rev Iberoam Cir Man 43(1):13–19CrossRefGoogle Scholar
  16. 16.
    Hay DC, Louie DL, Earp BE, Kaplan FT, Akelman E, Blazar PE (2014) Surgical findings in the treatment of Dupuytren’s disease after initial treatment with clostridial collagenase (Xiapex). J Hand Surg 39E(5):463–465CrossRefGoogle Scholar
  17. 17.
    Eberlin KR, Kobraei EM, Nyame TT, Bloom JM, Upton J (2015) Salvage palmar fasciectomy after initial treatment with Collagenase clostridium histolyticum. Plast Reconstr Surg 135(6):1000e–1006eCrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  • Clarisa Simón-Pérez
    • 1
  • Julian Alía-Ortega
    • 1
  • Belen García-Medrano
    • 1
  • Jose Ignacio Rodríguez-Mateos
    • 1
  • Maria Brotat-Rodríguez
    • 1
  • Hector Aguado-Hernandez
    • 1
  • Miguel Angel Martín-Ferrero
    • 1
  1. 1.Servicio de TraumatologíaHospital Clínico Universitario de ValladolidValladolidSpain

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