Related Experiment Video
Updated: Jun 23, 2025
Human Dupuytren's Ex Vivo Culture for the Study of Myofibroblasts and Extracellular Matrix Interactions
Published on: April 18, 2015
Collagenase Clostridium Histolyticum for the Treatment of Dupuytren Disease: A Delphi-Based Consensus Study
Gary M Pess1, David Hurley2, James R Verheyden3
1Central Jersey Hand Surgery, Eatontown, NJ.
Insights
Expert hand surgeons reached consensus on using collagenase clostridium histolyticum (CCH) for treating Dupuytren disease. CCH is appropriate for various patient populations and disease severities, including MP and PIP joint contractures.
Area of Science:
- Orthopedics
- Hand Surgery
- Pharmacology
Background:
- Dupuytren disease is a progressive condition affecting the hand.
- Collagenase clostridium histolyticum (CCH) is an enzymatic treatment option.
- Establishing expert consensus guides optimal CCH application.
Purpose of the Study:
- To develop consensus recommendations for using CCH in Dupuytren disease.
- To define appropriate patient populations and disease severities for CCH treatment.
- To address specific clinical scenarios impacting CCH treatment decisions.
Main Methods:
- A three-round, blinded, modified Delphi process was employed.
- Expert hand surgeons evaluated clinical scenarios involving CCH treatment.
- Consensus was defined as ≥66.7% agreement or disagreement.
Main Results:
- High consensus was achieved for CCH in MP and most PIP joint contractures.
- Specific scenarios (e.g., poor skin, scarring, boutonnière deformity) required modifications for consensus.
- Over 95% agreement was reached on modified statements regarding PIP contractures.
- Panelists deemed CCH appropriate for most Dupuytren disease patients.
Conclusions:
- Expert hand surgeons agree on the broad applicability of CCH for Dupuytren disease.
- CCH is recommended for diverse patient groups with varying disease severity and functional impairment.
- These recommendations provide guidance for optimizing CCH therapy in clinical practice.
Purpose:
The aim of this study was to establish the consensus recommendations among hand surgeons who were experts in the use of collagenase clostridium histolyticum (CCH) on the appropriate treatment of Dupuytren disease in well-defined patient populations with varying degrees of disease severity and functional impairment.
Methods:
A three-round, blinded, modified Delphi process examined panelists' approaches to CCH treatment of metacarpophalangeal (MP) or proximal interphalangeal (PIP) joint contractures involving one or two fingers with varying degrees of severity. Clinical scenarios related to poor-quality skin, postfasciectomy scarring, boutonnière deformity, closed capsulotomy, and blood thinner use were also presented for panelist consideration. Panelists provided responses to clinical scenarios using a 5-point Likert scale or a yes/no response. Consensus was defined as ≥66.7% panelist agreement or disagreement.
Results:
Twenty panelists completed round 1; 19 of the 20 panelists completed rounds 2 and 3. Panelists achieved a high level of consensus for using CCH for the treatment of patients with palpable cords and varying severity contractures representing one- or two-finger MP joint contractures, most one- or two-finger PIP joint contractures, and most combined MP and PIP joint contractures. Consensus for the treatment of PIP joint contractures was mostly achieved, but clinical scenarios related to recurrent PIP contracture with poor-quality skin and/or significant postfasciectomy scarring, boutonnière deformity, PIP contractures >70°, closed capsulotomy, and blood thinner use were modified, and then most (95.3%) statements reached consensus for agreement in round 2. In round 3, open-ended responses indicated that panelists considered CCH appropriate for most patients with Dupuytren disease.
Conclusions:
Consensus-based findings among expert hand surgeons with substantial CCH experience indicated that CCH has a wide-ranging application for the treatment of Dupuytren disease in patients with varying degrees of disease severity and functional impairment.
Type Of Study/Level Of Evidence:
Therapeutic V.
More Related Videos
13:45A Method to Study the Correlation Between Local Collagen Structure and Mechanical Properties of Atherosclerotic Plaque Fibrous Tissue
Published on: November 11, 2022
10:49Doxycycline Loaded Collagen-Chitosan Composite Scaffold for the Accelerated Healing of Diabetic Wounds
Published on: August 21, 2021