Early results of the use of collagenase in the treatment of Dupuytren's contracture.

INTRODUCTION: In recent years, the enzyme collagenase has been developed for the percutaneous treatment of Dupuytren's contracture, allowing management of the condition as an outpatient. We present early results on the treatment of Dupuytren's contracture using injectable collagenase.
METHODS: Patients awaiting Fasciectomy for Dupuytren's Contracture were selected for enrolment. Contracture cords were then marked and injected with collagenase in the outpatients department. Twenty-four hours later, patients returned for an extension procedure, performed under regional anaesthesia. Hand therapy was then commenced as for surgical release. Contracture angles were measured pre-injection and at follow-up.
RESULTS: Thirteen fingers were treated in 10 patients with a mean age of 66 years. Eight little fingers and five ring fingers were treated. Four fingers had isolated metacarpophalangeal joint (MCPJ) contracture, one finger had isolated proximal interphalangeal joint (PIPJ) contracture and the remainder had combined contractures. Mean pre-treatment MCPJ contracture was 58.6° and the mean pre-treatment PIPJ contracture was 39°. Post-treatment contracture was 4.23° and 9° for the MCPJ and PIPJ, respectively. All patients were satisfied with their results. COMPLICATIONS: Significant post-injection bruising occured in one patient. Skin tears occurred in 11 digits, and in all cases healed without intervention. No tendon rupture occurred.
CONCLUSIONS: Collagenase is a safe and effective outpatient-based treatment for Dupuytren's contracture, which may be useful in controlling surgical waiting lists. We recommend its use as first-line treatment in patients who are unsuitable more invasive treatment alternatives.