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Risk Factors for Skin Tears Following Collagenase Clostridium histolyticum to Treat Dupuytren Contractures.
J Hand Surg Am. 2020 Jun 13 [Online ahead of print]JH

Abstract

PURPOSE

Skin tears are an unpleasant complication that may occur after collagenase Clostridium histolyticum (CCH) administration to treat Dupuytren contractures of the fingers. The purpose of this study was to determine risk factors for the development of this complication.

METHODS

Over a 6-year period, patients with a measurable metacarpophalangeal or proximal interphalangeal joint Dupuytren contracture and a palpable cord treated with CCH were prospectively observed. Patients were assessed for the development of skin tears immediately on the day of manipulation as well 30 days or more after manipulation.

RESULTS

A total of 117 patients (174 cords) met inclusion criteria. There was a 25.6% incidence of skin tears (30 of 117 patients; 33 skin tears). Multivariable regression analysis revealed that patients with a combined digital flexion contracture (total combined metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joint contracture) of 75° and greater and those treated with 2 simultaneous doses of CCH in the same hand were more likely to sustain a tear. All skin tears healed with nonsurgical management at short-term follow-up.

CONCLUSIONS

Although a relatively minor complication, skin tears are not well-tolerated by all patients and may change the postinjection course of orthosis use, wound care, and manual activity. Based on these results, patients with digital contractures 75° or greater and those treated with 2 simultaneous doses of CCH in the same hand may be counseled that they have a higher likelihood of developing a skin tear during manipulation. Pretreatment education may reduce anxiety experienced by patients who otherwise unexpectedly develop a skin tear at the time of manipulation.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic II.

Authors+Show Affiliations

ONS Foundation for Clinical Research and Education, Greenwich, CT.ONS Foundation for Clinical Research and Education, Greenwich, CT.Center on Aging, University of Connecticut Health, Farmington, CT.ONS Foundation for Clinical Research and Education, Greenwich, CT. Electronic address: Vitale@onsmd.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32546304

Citation

Wei, David H., et al. "Risk Factors for Skin Tears Following Collagenase Clostridium Histolyticum to Treat Dupuytren Contractures." The Journal of Hand Surgery, 2020.
Wei DH, Cantlon MB, Wakefield DB, et al. Risk Factors for Skin Tears Following Collagenase Clostridium histolyticum to Treat Dupuytren Contractures. J Hand Surg Am. 2020.
Wei, D. H., Cantlon, M. B., Wakefield, D. B., & Vitale, M. A. (2020). Risk Factors for Skin Tears Following Collagenase Clostridium histolyticum to Treat Dupuytren Contractures. The Journal of Hand Surgery. https://doi.org/10.1016/j.jhsa.2020.04.022
Wei DH, et al. Risk Factors for Skin Tears Following Collagenase Clostridium Histolyticum to Treat Dupuytren Contractures. J Hand Surg Am. 2020 Jun 13; PubMed PMID: 32546304.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk Factors for Skin Tears Following Collagenase Clostridium histolyticum to Treat Dupuytren Contractures. AU - Wei,David H, AU - Cantlon,Matthew B, AU - Wakefield,Dorothy B, AU - Vitale,Mark A, Y1 - 2020/06/13/ PY - 2019/06/15/received PY - 2020/03/23/revised PY - 2020/04/23/accepted PY - 2020/6/18/entrez KW - CCH KW - Collagenase Clostridium histolyticum KW - Dupuytren contracture KW - Dupuytren disease KW - skin tear JF - The Journal of hand surgery JO - J Hand Surg Am N2 - PURPOSE: Skin tears are an unpleasant complication that may occur after collagenase Clostridium histolyticum (CCH) administration to treat Dupuytren contractures of the fingers. The purpose of this study was to determine risk factors for the development of this complication. METHODS: Over a 6-year period, patients with a measurable metacarpophalangeal or proximal interphalangeal joint Dupuytren contracture and a palpable cord treated with CCH were prospectively observed. Patients were assessed for the development of skin tears immediately on the day of manipulation as well 30 days or more after manipulation. RESULTS: A total of 117 patients (174 cords) met inclusion criteria. There was a 25.6% incidence of skin tears (30 of 117 patients; 33 skin tears). Multivariable regression analysis revealed that patients with a combined digital flexion contracture (total combined metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joint contracture) of 75° and greater and those treated with 2 simultaneous doses of CCH in the same hand were more likely to sustain a tear. All skin tears healed with nonsurgical management at short-term follow-up. CONCLUSIONS: Although a relatively minor complication, skin tears are not well-tolerated by all patients and may change the postinjection course of orthosis use, wound care, and manual activity. Based on these results, patients with digital contractures 75° or greater and those treated with 2 simultaneous doses of CCH in the same hand may be counseled that they have a higher likelihood of developing a skin tear during manipulation. Pretreatment education may reduce anxiety experienced by patients who otherwise unexpectedly develop a skin tear at the time of manipulation. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/32546304/Risk_Factors_for_Skin_Tears_Following_Collagenase_Clostridium_histolyticum_to_Treat_Dupuytren_Contractures L2 - https://linkinghub.elsevier.com/retrieve/pii/S0363-5023(20)30226-4 DB - PRIME DP - Unbound Medicine ER -
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