Background: Collagenase Clostridium histolyticum (CCH) injection and manipulation is a relatively new method for treating Dupuytren contracture that is growing in popularity. Although side effects such as swelling and ecchymosis are common, they are typically mild and self-limited. Major complications are rare but have included flexor tendon rupture and complex regional pain syndrome. Methods: This study describes a case report of 2 patients seen at our institution. Results: Here, we report 2 patients seen at our institution each with different, yet serious complications after CCH injection and manipulation. One patient had extensive skin loss and chose amputation over reconstruction. The other patient had loss of perfusion and required finger amputation. Conclusions: Although it is unclear how directly the administration of CCH is connected to the observed complications, physicians should recognize the potential for serious rare complications in any treatment of Dupuytren contracture.
DenklerK.Dupuytren’s fasciectomies in 60 consecutive digits using lidocaine with epinephrine and no tourniquet. Plast Reconstr Surg. 2005;115(3):802-810.
2.
ManningCJDelaneyRHaytonMJ.Efficacy and tolerability of day 2 manipulation and local anaesthesia after collagenase injection in patients with Dupuytren’s contracture. J Hand Surg Eur Vol. 2014;39(5):466-471. doi:10.1177/1753193413490899.
3.
PeimerCABlazarPColemanSKaplanFTSmithTLindauT.Dupuytren contracture recurrence following treatment with collagenase Clostridium histolyticum (CORDLESS [collagenase option for reduction of Dupuytren long-term evaluation of safety study]): 5-year data. J Hand Surg Am. 2015;40(8):1597-1605. doi:10.1016/j.jhsa.2015.04.036.
4.
PeimerCAMcGoldrickCAFioreGJ.Nonsurgical treatment of Dupuytren’s contracture: 1-year US post-marketing safety data for collagenase Clostridium histolyticum. Hand (N Y). 2012;7(2):143-146. doi:10.1007/s11552-012-9407-3.
5.
RydevikBEhiraTLinderLOlmarkerKRomanusMBranemarkPI.Microvascular response to locally injected collagenase. An experimental investigation in hamsters and rabbits. Scand J Plast Reconstr Surg Hand Surg. 1989;23(1):17-21.
6.
SpiersJDUllahADiasJJ.Vascular complication after collagenase injection and manipulation for Dupuytren’s contracture. J Hand Surg Eur Vol. 2014;39(5):554-556. doi:10.1177/1753193413517075.
7.
StarkweatherKDLattugaSHurstLCet alCollagenase in the treatment of Dupuytren’s disease: an in vitro study. J Hand Surg Am. 1996;21(3):490-495. doi:S0363-5023(96)80368-6.
8.
ThomsonCJLalondeDHDenklerKAFeichtAJ.A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. 2007;119(1):260-266. doi:10.1097/01.prs.0000237039.71227.11.
9.
ToyoshimaTMatsushitaOMinamiJNishiNOkabeAItanoT.Collagen-binding domain of a Clostridium histolyticum collagenase exhibits a broad substrate spectrum both in vitro and in vivo. Connect Tissue Res. 2001;42(4): 281-290.
