119.
Xiapex® (collagenase clostridium histolyticum) – treatment of
patients with recurrence Dupuytren’s contracture after fasciectomy
Søren Larsen , Jens Christian Werlinrud, Tune Ipsen, Jens Lauritsen
Department of Orthopaedic Surgery Odense University Hospital; Department
of Orthopaedic Surgery, Odense University Hospital; Department of
Orthopaedic Surgery, Odense University Hospital; tment of Orthopaedic
Surgery, Odense University Hospital
Background:
Dupuytren’s contracture (DC) is a disorder that affect the
palmar fascia where a pretendinous cord with time causes the finger to flex
resulting in impaired hand function. After surgical fasciectomy recurrence is
well known. Surgical re-fasciectomy is demanding and has a high
complication rate.
Purpose / Aim of Study:
The aim of this study was to evaluate the efficacy
and safety of Xiapex® in the treatment of recurrent DC after fasciectomy in
the same finger. The study was initiated following a Minimal Health
Technology Assessment.
Materials and Methods:
The study was a prospective study on consecutive
series of patients with recurrent DC following fasciectomy and flexion
deformities of the metacarpophalangeal and/or proximal interphalangeal joint
of >200 and a palpable cord. Primary end point was reduction in contracture
and improving hand function. All patients gave informed consent.
Findings / Results:
21
patients were enrolled, 17 men and 4 women, mean age
66
years [46-85]. 95 % of the treated fingers are the 4. and 5. finger. In the
series two patients denied injection in favour of surgery. At manipulation cord
disruption succeed in 95 % of the patients at the first attempt. Despite 76% had
skindisruption no infections were seen. Mean DASH pre-injection was 16 [0-
50]
and at 3 months follow-up 8 [0-43]. There was a mean reduction in
contracture of 36° [0-65°] At 3 months no joint had recurrence of contracture
and patient satisfaction was high.
Conclusions:
Our preliminary results are promising and we find Xiapex® a
good treatment option for recurrent DC-patients with a palpable cord. The
treatment is effective, well tolerated and without recurrence at 3 months.
