gms | German Medical Science

Introduction: Common treatment of Dupuytrens disease is the partial fasciectomy (PF). A possible alternative is the injection of collagenase (CI) directly into the cords to enzymatically destroy the collagen. In contrast to needle fasciotomy this technique is enzymatic and not mechanical. The treated finger is then extended after 24 hrs which provokes the rupture of the dupuytren cords.

Materials and Methods: In a prospective study functional results and patient’s satisfaction of two equal groups (PF, CI) with comparable stadia of the disease (Tubiana – pa: 2,62; ci: 2,79) were investigated in a period of one year. Additionally to the clinical examination the outcome was studied with validated questionnaires (DASH, MHQ).

Results: Extent of the extension of the treated fingers was better after PF (mean 8,2° residual contracture) than after CI (mean 17,3 residual contracture). Side-effects like numbness, pain and decreased perfusion were less and of a shorter duration after CI than after PF. The regeneration of the praeinterventionally measured level of strength was faster after CI than after PF, and the CI was less incriminatory. The results of the questionnaires showed a decreased function of the hands one month after treatment. Patients could start their work two weeks earlier after CI.

Discussion: Although the results of the ameliorated extension were better after PF, patients who received CI were more satisfied with the outcome of the treatment. This procedure was perceived less incriminatory to the patient and the side effects were of shorter duration. Additionally, they were less surgeon-dependent. After one year the CI showed comparable recurrence rates to PF although new cords occurred, which would have been removed by surgery. This demonstrates lower recurrence-rates of the CI than the needle fasciotomy (van Rijssen 2012: 88%). Long-term-results will have to prove that CI is an alternative to PF.