Objectives: This study compared Collagenase Clostridium Histolyticum (CCH) injection and limited fasciectomy (LF) in terms of early post-interventional soft tissue conditions and patient burden, evaluated by visit frequency to surgeons and hand therapists, complications, and reintervention rates.
Materials and methods: Consecutive patients undergoing CCH injection or LF as first-line treatment for Dupuytren's disease over 15 years were assessed. Propensity score matching minimized selection bias. The primary outcome was the assessment of early post-interventional (between 2 and 8 weeks) soft tissue condition using a novel Soft Tissue Score with points assigned for documented swelling, hyperemia, induration, and tenderness. Secondary outcomes included the number of surgeon and hand therapy visits, as well as the complication and reintervention rates in a subgroup of patients followed for at least 4 months.
Results: After propensity score matching, two treatment groups of 26 patients each were formed (CCH vs. LF group). There were no significant differences in baseline characteristics and correction of flexion contracture between the two treatment groups. The early postinterventional Soft Tissue Score was significantly worse in the LF group than in the CCH group (mean 1.35 vs. 0.65 points, MD 0.7, 95 % CI [0.2, 1.2], p = 0.022). The number of surgeon and hand therapy visits was significantly higher in the LF group (mean 4.7 vs. 1.9 visits, MD 2.8, 95 % CI [1.8, 3.8], p < 0.001 and mean 10.5 vs. 4.3 visits, MD 6.2, 95 % CI [0.7, 11.7], p = 0.036, respectively). The rate of mild and severe complications was comparable in both groups. While the reintervention rate was significantly higher in the CCH group, the occurrence of multiple reinterventions was comparable.
Conclusion: The results of this study suggest that CCH injections lead to less complicated wound healing requiring less intensive surgeon and hand therapy aftercare than LF. CCH represents a valuable addition to Dupuytren's disease treatment, allowing for repeated use in severe, complex, or recurrent cases without increasing procedure-related risks while offering versatility for combination with minimally invasive surgery.
Keywords: Collagenase Clostridium Histolyticum; Collagenase injection; Dupuytren's contracture; Dupuytren's disease; Limited fasciectomy.
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