Dupuytren’s contracture is a fibroproliferate disease where collagen accumulates in the palmar fascia of the hand. That is to say, It leads to the formation of cords and nodules which leaves an irreversible fixed flexion contracture of the hand. In fact, Dupuytren’s contracture is not limited to hands, it may occur in the foot sole or penis.
Ways to treat Dupuytren’s contracture:
Surgery is the major approach to treat Dupuytren’s contracture, yet non surgical treatments exist. Nonetheless, Limited fasciectomy is the most common treatment and it’s a non surgical approach. Indeed, the methods used are challenging, where all has benefits and drawbacks.
-Percutaneous needle anoneurotomy (PNA)
-Collagenase Clostridium Histolyticum (CCH)
-Botulinum toxin A
CCH is a non surgical method, where the enzyme is injected into the Dupuytren’s cord, then the contracture is bloated by manual rupturing.
Comparing limited fasciectomy (LF) to percutaneous needle aponeurotomy (PNA):
LF and PNA were compared regarding the treatment they offer to patients and the results are as follows:
-PNA: Early recurrence, faster recovery and hardly any complications
-LF: Late recurrence, Slower recovery and more complications
Comparing percutaneous needle aponeurotomy (PNA) and collagenase clostridium histolyticum (CCH):
Markedly, both PNA and CCH has treated the patient’s equally with only few complications such as skin tears, edema, ecchymosis, pruritus and lymphadenopathy.
Complications of Dupuytren's contracture treatments:
-Recurrence of contracture
-Digital nerve damage or postoperative neurataxia
-Flexor tension injury or rupture
-Skin necrosis or long healing duration
-Dysvascular digit or arterial injury
-Hematoma
-Infection
References:
-Fitzpatrick AV, Moltaji S, Ramji M, Martin S. Systematic Review Comparing Cost Analyses of Fasciectomy, Needle Aponeurotomy, and Collagenase Injection for Treatment of Dupuytren's Contracture: Une analyse de coûts systématique comparant la fasciectomie, l'aponévrotomie percutanée à l'aiguille et l'injection de collagénase pou traiter la maladie de Dupuytren. Plast Surg (Oakv). 2021 Nov;29(4):257-264. doi: 10.1177/2292550320963111. Epub 2020 Oct 16. PMID: 34760842; PMCID: PMC8573646.
-Davis SM, Chang EY. Dupuytren's contracture treated with botulinum toxin A injection. Arch Clin Cases. 2021 Oct 27;7(4):63-67. doi: 10.22551/2020.29.0704.10175. PMID: 34754930; PMCID: PMC8565707.
-Hovius SER, Zhou C. Advances in Minimally Invasive Treatment of Dupuytren Disease. Hand Clin. 2018 Aug;34(3):417-426. doi: 10.1016/j.hcl.2018.03.010. PMID: 30012301.
-Holzer LA, Holzer G. Kollagenase Clostridium histolyticum im Management der Dupuytrenschen Kontraktur [Collagenase Clostridum histolyticum in the management of Dupuytren's contracture]. Handchir Mikrochir Plast Chir. 2011 Oct;43(5):269-74. German. doi: 10.1055/s-0031-1286314. Epub 2011 Sep 20. PMID: 21935843.
-Desai SS, Hentz VR. The treatment of Dupuytren disease. J Hand Surg Am. 2011 May;36(5):936-42. doi: 10.1016/j.jhsa.2011.03.002. PMID: 21527148.
-Nydick JA, Olliff BW, Garcia MJ, Hess AV, Stone JD. A comparison of percutaneous needle fasciotomy and collagenase injection for dupuytren disease. J Hand Surg Am. 2013 Dec;38(12):2377-80. doi: 10.1016/j.jhsa.2013.08.096. Epub 2013 Sep 20. PMID: 24060510.
-Kaplan FTD, Crosby NE. Treatment of Recurrent Dupuytren Disease. Hand Clin. 2018 Aug;34(3):403-415. doi: 10.1016/j.hcl.2018.03.009. PMID: 30012300.
-Eberlin KR, Mudgal CS. Complications of Treatment for Dupuytren Disease. Hand Clin. 2018 Aug;34(3):387-394. doi: 10.1016/j.hcl.2018.03.007. Epub 2018 Jun 8. PMID: 30012298.
