Skin Laceration in Collagenase Clostridium histolyticum Treatment for Dupuytren's Contracture. 2018

Rafael Sanjuan-Cervero, and Francisco J Carrera-Hueso, and Salvador Oliver-Mengual, and Maria A Ramon-Barrios, and Clayton A Peimer, and Narjis Fikri-Benbrahim
Rafael 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. OBJECTIVE 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). METHODS 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.

UI MeSH Term Description Entries
D008297 Male Males
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D003012 Microbial Collagenase A metalloproteinase which degrades helical regions of native collagen to small fragments. Preferred cleavage is -Gly in the sequence -Pro-Xaa-Gly-Pro-. Six forms (or 2 classes) have been isolated from Clostridium histolyticum that are immunologically cross-reactive but possess different sequences and different specificities. Other variants have been isolated from Bacillus cereus, Empedobacter collagenolyticum, Pseudomonas marinoglutinosa, and species of Vibrio and Streptomyces. EC 3.4.24.3. Clostridiopeptidase A,Clostridium histolyticum Collagenase,Collagenase, Microbial,Collagenase Clostridium histolyticum,Collagenase-Like Peptidase,Collalysine,Nucleolysin,Clostridium histolyticum, Collagenase,Collagenase Like Peptidase,Collagenase, Clostridium histolyticum,Peptidase, Collagenase-Like,histolyticum, Collagenase Clostridium
D004387 Dupuytren Contracture A fibromatosis of the palmar fascia characterized by thickening and contracture of the fibrous bands on the palmar surfaces of the hand and fingers. It arises most commonly in men between the ages of 30 and 50. Dupuytren's Contracture,Dupuytren's Disease,Fibromatosis, Palmar,Contracture, Dupuytren,Contracture, Dupuytren's,Dupuytren Disease,Dupuytrens Contracture,Dupuytrens Disease,Palmar Fibromatosis
D005260 Female Females
D006225 Hand The distal part of the arm beyond the wrist in humans and primates, that includes the palm, fingers, and thumb. Hands
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D014945 Wound Healing Restoration of integrity to traumatized tissue. Healing, Wound,Healings, Wound,Wound Healings

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