Recently a minimal invasive therapeutic option by means of enzymatic lysis of Dupuytren's cord was introduced in Europe under the name Xiapex® (Pfizer, Germany).Here we present our first experiences in clinical application with special remarks on complications.In this study 16 injections on 12 Dupuytren's cords in 8 patients were conducted. The average age of the patients was 62.5 (48-74) years. Constitution and application were carried out according to the manufacturer's guidelines. If both the metacarpophalangeal (MP)- and the proximal interphalangeal (PIP) joint were affected, injections were carried out on different points in time. 5 injections were done for contracture of the MPjoint, 4 injections for the PIPjoint, and 3 injections of both, the MP- and PIPjoint. Before the treatment and after 2 weeks the contracture of the treated joint was measured with use of a goniometer for small joints. Side effects and complications were documented as well as whether patients needed - and if yes, for how many days - a pain medication.Total flexion contracture of treated joints could be significantly reduced from 103°±12° to 37°±9°. In MPjoints the flexion contracture was reduced from 47°±8° to 14°±5° and in PIPjoints from 69°±10° to 37°±11° (p<0.05). 5 treated cords showed no signs of complication, recorded local adverse effects were edema (n=5), erythema (n=4) and tearing of skin (n=2). 6 patients needed pain medication for a maximum of 4 days.Treatment with collagenase appears to be an effective and safe therapeutic option for selective cases. Though the procedure ostensibly seems easy, one must emphasize the need for the appropriate application performed only by professionals with a high level of experience both in anatomical knowledge as well as hand surgical know-how to cope potential complications. The value of the new method in relation to the standard partial aponeurectomy and percutaneous needle fasciotomy needs to be ascertained by further research in order to establish a clear indication for each method of treatment.
Georg Thieme Verlag KG Stuttgart · New York.