Preparation, Injection and Traction Procedures (Pearls and Tips and Tricks): Technical Evolution and Results in Severe Cases

  • Giorgio Pajardi
  • Chiara Parolo


Collagenase Clostridium histolyticum (CCH) was approved both in the United States (US) and Europe (EU) for adults with Dupuytren contracture (DC) [18] for the non-surgical treatment of a single palpable cord and has become a good alternative to surgical correction of DC. The dose suggested for a single treatment is 0.58 mg. In case additional treatment is required, the next injections are given after 30 days. However, recent studies revealed that treatment of multiple joints using two concurrent injections resulted in comparable improvement to those seen in previous studies. Multiple 0.58 mg concurrent injections is approved in the US for effective treatment of patients with multiple affected joints would benefit the patient and enhance the cost-effectiveness of the drug, which is otherwise currently a challenge (Fig. 5.1). Dividing a single dose of CCH into aliquots is an alternative successful treatment of complex combined cords like the “Y” cord (Fig. 5.2). A single dose can also be divided to treat two separate cords that are not connected (Fig. 5.3). However, success will be determined by the thickness of the cords, since the volume splitting will only work if they are very thin with a small cross-sectional diameter.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Giorgio Pajardi
    • 1
  • Chiara Parolo
    • 2
  1. 1.Plastic and Reconstructive Surgery, Orthopedic Surgery, Department of Hand SurgerySan Giuseppe Multimedica Hospital, University of MilanMilanItaly
  2. 2.Plastic and Reconstructive Surgery, Department of Hand SurgerySan Giuseppe Multimedica Hospital, University of MilanMilanItaly

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