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Research Letter
Association of VA Surgeons
October 19, 2016

Treatment of Dupuytren Contracture With Injectable Collagenase Within the Veterans Affairs System

Author Affiliations
  • 1Division of Plastic Surgery, Department of Surgery, Indiana University, Indianapolis
  • 2Division of Plastic Surgery, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
JAMA Surg. Published online October 19, 2016. doi:10.1001/jamasurg.2016.3605

Dupuytren contracture is a debilitating disease involving abnormal thickening of the palmar fascia, resulting in pits, nodules, and cords that lead to contracture of the digits. Prevalence in the veteran population is approximately 306 per 100 000 individuals.1 Surgical management of Dupuytren contracture includes removal or release of the fascia via open fasciectomy, open fasciotomy, closed fasciotomy, and most recently, injectable collagenase. A double-blind placebo-controlled trial published in 2010 showed a significantly greater mean increase in range of motion in the group that received collagenase (35.4°) than in the group that received placebo (7.6°) (P < .001); in addition, 50.7% of all joints treated with collagenase achieved a range of motion 0° to 5° of normal.2 With the US Food and Drug Administration approval of collagenase from Clostridium histolyticum in 2010, it was predicted that there would be increased use of collagenase, with an associated decrease in palmar fasciectomy and fasciotomy within the Veterans Affairs (VA) system.

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