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A Comparison of Injectable Collagenase Clostridium Histolyticum and Palmar Fasciectomy: A Single Institution's Experience
Tyler Evans, MD; Sarah E. Sasor, MD; Rajiv Sood, MD; Sunil S. Tholpady, MD; Adam Cohen, MD
Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN
Introduction: Dupuytren’s disease is fibroproliferative disorder characterized by thickening and shortening of the palmar fascia, leading to debilitating flexion contractures of the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints. In the US, prevalence of Dupuytren’s disease has been estimated to be 1-4%, but studies show a higher preponderance in elderly males of Northern European descent.1 Palmar fasciectomy historically has been the treatment of choice, but newly approved injectable collagenase clostridium histolyticum (Xiaflex) may give surgeons an efficient, cost effective treatment alternative. This study was designed to compare a single institution’s experience with the two treatment modalities.
Methods: A single-center retrospective review was conducted including patients undergoing Xiaflex injections or fasciectomy for Dupuytren’s contractures since 2013. Demographics including age, gender, smoking status and race were obtained. Outcome data including degrees of flexion contracture pre- and post-procedure, cost, and number of clinic/OT visits were recorded. Complications including infection, hematoma, wound healing issues, and tendon injury were obtained.
Results: A total of 19 patients (23 procedures) were injected with Xiaflex and 8 patients underwent fasciectomies. All patients were white males with an average age of 65. Approximately 53% of Xiaflex patients were smokers. The only complications with Xiaflex were minor skin tears (17.4%). In the fasciectomy group, 3 out of 8 had minor complications. No tendon injuries were reported in either group. All patients undergoing either Xiaflex or fasciectomy had >50% reduction in flexion contracture. Average number of post-procedure clinic visits and OT sessions for Xiaflex patients were 2.2 and 3, respectively, and 3 and 7.4 in fasciectomy patients. Average cost associated with fasciectomy was ,250.61, while the average cost of Xiaflex injection was $3,500.
Conclusions: Injectable collagenase clostridium histolyticum appears to be a practical, safe and cost saving treatment for Dupuytren’s contractures. Hand surgeons should consider this treatment option, especially in smokers, to reduce overall costs and the rehabilitation burden on patients.
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