Nonoperative treatment for Dupuytren’s contracture by collagenase. First results and socioeconomical effects

Surgery is the classical treatment of Dupuytren’s contracture, but it still carries a risk of recurrence or extension.Collagenase (clostridium histolyticum) breaks down and resorbs Dupuytren’s cord. The results of preliminary studies from Badalamente and Hurst’s (1) team in New York were convincing enough for approval by the Food and Drug Administration. Clostridium histolyticum collagenase was authorized for the European market on February 28, 2011, and its reimbursement by the national health fund allowed its use in the Grand Duchy of Luxembourg since April 2012.The therapeutic method consists of a single, simple, direct injection in Dupuytren’s digitopalmar cord at Tubiana stage 1. The cord is broken down 24 hours later, under local anesthesia, by direct traction of the digital chain.Immediately after this extension procedure, the patient wears a dynamic extension splint at night for a maximum of four months. The effectiveness of the collagenase contraindicates its use in digital chains to avoid injury to the neurovascular bundles.We report here our experience with 12 patients treated with collagenase clostridium histolyticum. All patients regained radii extension which negative the « table top test », without local or general complication.Despite the low number of studies on the long-term recurrence rate of recurrence, this new therapeutic tool results in significant rates of patient satisfaction, as high as 88% for Watt et al (2).Concerning that this non-surgical procedure is minimally invasive and is associated with low morbidity, all of our patients indicate they would be repeat it in case of recurrence or extension of the disease, especially if they have had been previously managed with surgery.Although the cost of the collagenase is high (€ 701.79, VAT not included), and approaches the overall cost of palmar fasciectomy surgery, there is a real socioeconomical benefit of using the collagenase as it reduces work leave for manual workers from a minimum of five weeks to a maximum of one week.