DUPUYTREN’S CONTRACTURE TREATED WITH COLLAGENASE CLOSTRIDIUM HISTOLYTICUM
DOI:
https://doi.org/10.61751/ijmmr.2413-6077.2023.1.39Keywords:
palmar fibromatosis, minimally invasive intervention, hand surgery, open fasciectomy, clinical trial, patient managementAbstract
Treatment of Dupuytren’s contracture improves the quality of life of patients, but standard open fasciectomy
surgery is traumatic and requires long-term rehabilitation. The study aimed to determine whether injectable treatment
with collagenase preparations was effective in comparison with open fasciectomy. Forty patients were examined. Of these,
15 were treated with Clostridium histolyticum collagenase preparations (the main group), and 25 underwent limited fasciectomy (the control group). In 11 (73.3%) patients of the main group, restoration of mobility of the affected joints was
achieved after the first injection, in 3 (20%) – after the second, and in 1 (6.7%) – after the third. Patients in the main
group remained able to work after treatment and did not require rehabilitation; the function of the upper limb was fully
restored on the day of intervention. During the observation period, 12 (80%) patients in the main group were concerned
about dry skin at the intervention site, and 5 (33.3%) patients were concerned about itching and discolouration of the
skin at the intervention site. In 25 (100%) patients of the control group, joint mobility was fully restored. The ability to use
the hand after surgery in patients of the control group was limited for 6 (4.5; 10) days. All patients in the control group
required rehabilitation to relieve stiffness and restore the functional capabilities of the hand. The period of disability in
these patients lasted 16 (12; 24.5) days. 11 (44%) patients had complaints of pain or discomfort in the intervention area
during the follow-up, and 24 (96%) patients were bothered by itching. Satisfaction with the choice of treatment method
in the main group was more frequent compared to the control group. Relapses during the observation period were absent
in both groups. Thus, the efficacy of Clostridium histolyticum collagenase preparations are comparable to the results of
surgical treatment. Minimally invasive treatment is optimal for patients with mild disease, as well as for those who have a
low risk of contracture recurrence. The results of this study can be useful for surgeons when choosing the optimal method
of treating Dupuytren’s contracture
Received: 22.02.2023 | Revised: 28.04.2023 | Accepted: 30.05.2023
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