October 24, 2016
Patient Satisfaction with Collagenase rather than Surgery for Dupuytren's Disease
Collagenase injection for mild to moderate Dupuytren's contracture is used to rupture the Dupuytren's cord and improve the posture of one's finger without actual removal of the otherwise prominent disease. A study by Witthaut reported 71% of patients being very satisfied and most recently a study by Bradley and Warwick from the United Kingdom in the Journal of Hand Surgery, June 2016, page 689- 697, yielded about an 80% satisfaction with collagenase. That leaves 1 out of 5 patients dissatisfied with this treatment. One must keep in mind that collagenase treatment also fails in a high percentage of patients within two years of administration. I am not a proponent of collagenase because it is extremely costly, time-consuming and does not preclude an equivalent result with percutaneous needling of the Dupuytren's cord or ultimate surgical removal of the Dupuytren's tissue. Collagenase is a choice that is best suited for someone who is not felt to be a good candidate for surgery in terms of lack of cooperation, but still I am not certain that it is better than needling in the bulk of patients that is offered but yet at an extremely high cost.