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Skin Laceration in Collagenase Clostridium histolyticum Treatment for Dupuytren's Contracture
Rafael Sanjuan-Cervero1, Francisco J Carrera-Hueso, Salvador Oliver-Mengual
1Rafael Sanjuan-Cervero, MS, Orthopaedic Surgeon, Orthopedics and Traumatology Surgery, Hospital de Denia, Partida Beniadlà, Alicante, Spain; and Doctoral Program in Pharmacy, University of Granada, Granada, Spain. Francisco J. Carrera-Hueso, PhD, PharmD, Pharmacy Service, Hospital Dr Moliner, Valencia, Spain. Salvador Oliver-Mengual, BSN, Nursery, Grade of Nurse, Orthopedics and Traumatology Surgery, Hospital de Denia, Alicante, Spain. Maria A. Ramon-Barrios, BSN, Nursery, Grade of Nurse, Pharmacy Service, Hospital Dr Moliner, Valencia, Spain. Clayton A. Peimer, MD, Orthopaedic Surgeon, UP Health System Marquette/Duke Life Point, Marquette, MI. Narjis Fikri-Benbrahim, PhD, PharmD, Researcher, Academic Center in Pharmaceutical Care, University of Granada, Granada, Spain.
Background:
Dupuytren's contracture produces a progressive flexion contracture of the affected fingers. Collagenase Clostridium histolyticum produces breakdown of the cord in the hand and/or finger(s) that tightens as a result of the disease creating a contracture, allowing manual traction and cord rupture. One of the side effects is spontaneous skin laceration when the finger is extended.
Objectives:
To evaluate the development of skin lacerations in Dupuytren's contracture treated with collagenase Clostridium histolyticum, to determine predisposing factors, and evaluate the effectiveness of 2 different treatments (antiseptic and non-antiseptic dressings).
Participants:
Included 157 patients diagnosed with Dupuytren's contracture and treated with collagenase Clostridium histolyticum.
Methods:
Analysis of variables and logistic regression model were applied to determine their possible relationship with skin lacerations. The effectiveness of the type of treatment used was evaluated by comparing the amount of time required for healing.
Results:
Skin lacerations were present in 33.1% (n = 52) of patients, with an average laceration length of 1.12 (SD: 0.70) cm. Characteristics that were significant predisposing factors for lacerations were disease bilateralism (p = .002), previous surgical intervention (p = .003), and initial matacarpophalangeal joint contracture (p < .001). Worse initial contracture (Z = 5.94; p < .001) had a greater risk of laceration as did those who had prior hand surgery, or whose little finger was affected. Average treatment length of healing was 11.24 days (SD: 8.13). All wounds healed successfully. There were no significant differences (p = .511) in healing between different dressings evaluated.
Conclusions:
Skin lacerations as a consequence of treating Dupuytren's contracture with collagenase Clostridium histolyticum occur often and are moderately serious. For all cases, evolution is satisfactory in less than 2 weeks, and the type of treatment does not appear to make any difference in healing time.
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