gms | German Medical Science

Objectives/Interrogation: Collagenase Clostridium histolyticum (CCH) is a widely accepted alternative treatment option to surgery for Dupuytren's disease (DD). Recommended amount of CCH for MCP joints is 0.58 mg in a volume of 0.25 ml and for PIP joints 0.58 mg in a volume of 0.20 ml. The rest of collagenase vial is disposed of. We think there is no reason not to use the whole vial of CCH. Also, the recommended total amount of injected volume seems to be so small to cure enough tissue affected with DD. We tried to use the whole vial of CCH with less concentrated dilution to find if this approach is safe and effective.

Methods: Patients with DD and with total finger extension deficit (MCP + PIP) more than 30 degrees were indicated for CCH treatment. We excluded patients with previous surgery at the site of CCH injection. In all cases, only one infiltration was applied. We used the whole vial of CCH (0.9 mg) and we dissolved it in the volume of 1.0 ml of solvent. The fingers were manipulated under the wrist block 24 hour later. The follow-up included a minimum of 4 weeks after the treatment.

Results and Conclusions: Between October 2014 and September 2018 total of forty-seven hands of forty-three patients were treated with more diluted CCH. All treated hands had a cord rupture or nodules dissolved at the site of injection. All patients respond and all patients improved their total extension deficit of treated finger. No one patients reported unsatisfactory results. Adverse effects occur in all patients, the most serious were larger skin tears and hematoma of arm and forearm and transient axillar lymphadenopathy. All these side-effects of CCH activity disappeared spontaneously or with conservative treatment (analgesics, cooling, local antibiotic ointments) during 3-10 days. Any major complications, e.g. tendon rupture, anaphylaxis, CRPS, continuous pain etc. were not recorded.

We demonstrate that the use of the whole vial of the CCH is safe. Based on our experience, we also think, that dilution of 0.9mg of CCH into 1.0ml of the solvent has similar effectivity as original dilution and it allows for the treatment more amount of affected tissue. Total follow-up of 4 weeks we consider as enough time to find if our approach is effective and safe. We can conclude that dilution the whole vial of CCH into 1.0 ml of solvent seems to be safe and effective and increases a total amount of possibly treated tissue without decreasing the collagenase activity. Using whole vial od CCH can improve the economic aspects of DD treatment.