DIFFUSION OF INJECTED COLLAGENASE CLOSTRIDIUM HISTOLYTICUM FOR DUPUYTREN´S DISEASE: AN IN-VIVO STUDY

While injecting Clostridium Histolyticum as a non-surgical tratment for Dupuytrens disease on the palmar side of the hand the recommended depth of the needle should be “around 2 to 3 mm in depth”. The diffusion of CCH inside the soft tissues around the cord might explain the occurrence of common adverse events reported in the literature such as oedema, injection site swelling, blood blisters, skin laceration, and pain in extremity. We hypothesized that the injected Collagenase Clostridium Histolyticum does not only concentrate inside the cord but also dissipates both along the cord and into the adjacent tissues. This study investigated our hypothesis by visual intraoperative findings after injecting Povidone iodine into the cord.

Povidone iodine  (PI)was injected into the cord on six patients with Dupuytrens contracture before an open surgical operation (partial fasciectomy). We marked three hypothetical Collagenase Clostridium Histolyticum injection points at 2 mm intervals on the skin above the cord around the metacarpo-phalangeal joint and the depth of the injection (distance from the skin surface to the middle of the cord) was measured by ultrasonography. After dispensing 0.25 ml of Povidone iodine into the three points at the measured depths, we performed careful dissection and investigated the extent of diffusion of Povidone iodine visually.

The injection depth averaged 2.6 mm. In all cases, the cord was homogenously stained about 10 mm along its extent centrally to the injected sites and infiltration of Povidone iodine into the subcutaneous structure and fat tissue occurred. Three cases showed diffusion into the neurovascular bundles and two cases showed infiltration underneath the cord structure.

This study simulated the likely diffusion outcomes of injected Collagenase Clostridium Histolyticum around the cord. This implies that even if Collagenase Clostridium Histolyticum is injected into the centre of the cord, it does not concentrate inside the cord only but also dissipates along the cord and infiltrates into the adjacent tissues with potential secondary damages.