Recurrence after Surgery for Dupuytren’s Disease: A Randomized Trial of Two Skin Incisions

Citron, N.; Nuñez, Valerie

doi:10.1016/j.jhsb.2005.07.001

Cited by 57 publications

(48 citation statements)

References 9 publications

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“…The definition of complex regional pain syndrome is variable among practitioners and may explain the high rate of 13% in the study by Citron et al [8].…”

Section: Study Characteristicsmentioning

confidence: 99%

A Systematic Review of Outcomes of Fasciotomy, Aponeurotomy, and Collagenase Treatments for Dupuytren's Contracture

Chen

Srinivasan

Shauver

et al. 2011

Hand (New York, N,Y.)

114

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Background Needle aponeurotomy and collagenase injection are alternative treatments of Dupuytren's contracture to open partial fasciectomy; however, reported data are difficult to interpret without a formal systematic review. Methods A Medline, EMBASE, and Cochrane database search was performed, and 277 articles were identified. Articles were stratified by level of evidence, and those of the highest level for each technique were included. Evidence available for needle aponeurotomy was of low quality so only cohorts larger than 100 patients were included. Results The sample size of patients for open partial fasciectomy ranged from 37-261. The recurrence rate ranged from 12-39%, with mean follow-up time of 1.5-7.3 years. The complication rate ranged from 14-67%. Complications included nerve division (2-5%), infection (4-12%), neurapraxia (0.4-52%), and regional pain syndrome (2-13%). For needle aponeurotomy the sample size ranged from 117-211. The recurrence rate ranged from 50-58%, with mean follow-up time of 3-5 years. With regard to collagenase injection, the sample size ranged from 13-204. The recurrence rate ranged from 10-31%, with mean follow-up time of 120 days to 4 years. For the two latter procedures, adverse effects consisted primarily of skin tears (9-25%). Kruskal-Wallis testing demonstrated that the recurrence rate was significantly higher for needle aponeurotomy than for open partial fasciectomy (p=0.001), and the recurrence rate was significantly higher for open partial fasciectomy than for collagenase injection (p=0.001). Conclusions The recurrence rates and types of complications differ between open partial fasciectomy and needle aponeurotomy or collagenase injection. Long-term outcomes have not been well reported.

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“…The definition of complex regional pain syndrome is variable among practitioners and may explain the high rate of 13% in the study by Citron et al [8].…”

Section: Study Characteristicsmentioning

confidence: 99%

A Systematic Review of Outcomes of Fasciotomy, Aponeurotomy, and Collagenase Treatments for Dupuytren's Contracture

Chen

Srinivasan

Shauver

et al. 2011

Hand (New York, N,Y.)

114

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“…A total of eight RCTs were included in the review, seven full-text papers 55,56,64,65,[67][68][69] and one abstract.…”

Section: Study Detailsmentioning

confidence: 99%

“…[77][78][79][80][81][84][85][86][87][89][90][91] Four collagenase versus placebo RCTs were conducted in the USA, 55,[63][64][65] and one was conducted in Australia. 56 Two of the surgical RCTs took place in the UK 67,68 and one in the Netherlands. 69 The two non-randomised studies assessing collagenase versus surgery were both conducted in the USA.…”

Section: Assessment Of Clinical Effectivenessmentioning

confidence: 99%

“…[67][68][69] All eight trials involved consecutive enrolment of participants and prospective data collection.…”

mentioning

confidence: 99%

“…The three surgery RCTs focused on participants with primary occurrence of the disease. [67][68][69] Three of the surgery non-randomised comparative studies enrolled participants with primary disease, [74][75][76] one reported treating both participants with primary disease and participants previously treated 73 and one did not provide this information. 57 Eight of the collagenase case series involved both participants with primary disease and participants previously treated, 77- …”

mentioning

confidence: 99%

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Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Brazzelli

Cruickshank

Tassie

et al. 2015

Health Technol Assess

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BackgroundDupuytren’s disease is a slowly progressive condition of the hand, characterised by the formation of nodules in the palm that gradually develop into fibrotic cords. Contracture of the cords produces deformities of the fingers. Surgery is recommended for moderate and severe contractures, but complications and/or recurrences are frequent. Collagenase clostridium histolyticum (CCH) has been developed as a minimally invasive alternative to surgery for some patients.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of collagenase as an alternative to surgery for adults with Dupuytren’s contracture with a palpable cord.Data sourcesWe searched all major electronic databases from 1990 to February 2014.Review methodsRandomised controlled trials (RCTs), non-randomised comparative studies and observational studies involving collagenase and/or surgical interventions were considered. Two reviewers independently extracted data and assessed risk of bias of included studies. A de novo Markov model was developed to assess cost-effectiveness of collagenase, percutaneous needle fasciotomy (PNF) and limited fasciectomy (LF). Results were reported as incremental cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were undertaken to investigate model and parameter uncertainty.ResultsFive RCTs comparing collagenase with placebo (493 participants), three RCTs comparing surgical techniques (334 participants), two non-randomised studies comparing collagenase and surgery (105 participants), five non-randomised comparative studies assessing various surgical procedures (3571 participants) and 15 collagenase case series (3154 participants) were included. Meta-analyses of RCTs assessing CCH versus placebo were performed. Joints randomised to collagenase were more likely to achieve clinical success. Collagenase-treated participants experienced significant reduction in contracture and an increased range of motion compared with placebo-treated participants. Participants treated with collagenase also experienced significantly more adverse events, most of which were mild or moderate. Four serious adverse events were observed in the collagenase group: two tendon ruptures, one pulley rupture and one complex regional pain syndrome. Two tendon ruptures were also reported in two collagenase case series. Non-randomised studies comparing collagenase with surgery produced variable results and were at high risk of bias. Serious adverse events across surgery studies were low. Recurrence rates ranged from 0% (at 90 days) to 100% (at 8 years) for collagenase and from 0% (at 2.7 years for fasciectomy) to 85% (at 5 years for PNF) for surgery. The results of the de novo economic analysis show that PNF was the cheapest treatment option, whereas LF generated the greatest QALY gains. Collagenase was more costly and generated fewer QALYs compared with LF. LF was £1199 more costly and generated an additional 0.11 QALYs in comparison with PNF. The incremental cost-effectiveness ratio was £10,871 per QALY gained. Two subgroup analyses were conducted for a population of patients with moderate and severe disease and up to two joints affected. In both subgroup analyses, collagenase remained dominated.LimitationsThe main limitation of the review was the lack of head-to-head RCTs comparing collagenase with surgery and the limited evidence base for estimating the effects of specific surgical procedures (fasciectomy and PNF). Substantial differences across studies further limited the comparability of available evidence. The economic model was derived from a naive indirect comparison and was hindered by a lack of suitable data. In addition, there was considerable uncertainty about the appropriateness of many assumptions and parameters used in the model.ConclusionsCollagenase was significantly better than placebo. There was no evidence that collagenase was clinically better or worse than surgical treatments. LF was the most cost-effective choice to treat moderate to severe contractures, whereas collagenase was not. However, the results of the cost–utility analysis are based on a naive indirect comparison of clinical effectiveness, and a RCT is required to confirm or refute these findings.Study registrationThis study is registered as PROSPERO CRD42013006248.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Surgery for Dupuytren's contracture of the fingers

Rodrigues

Becker

Ball

et al. 2015

Cochrane Database of Systematic Reviews

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Data collection and analysis A minimum of two review authors independently reviewed search results to select studies for inclusion by using pre-specified criteria, assessed risk of bias of included studies and extracted data from included studies. We grouped outcomes into the following categories: (1) hand function, (2) other patient-reported outcomes (e.g. satisfaction, pain), (3) early objective outcomes (e.g. correction of angular deformity), (4) late objective outcomes (e.g. recurrence) and (5) adverse effects. Main results We included 14 articles describing 13 studies, comprising 11 single-centre studies and two multi-centre studies. These studies involved 944 hands of 940 participants; of these, 93 participants were reported twice in separate articles describing early and late outcomes of one trial. Three papers reported the outcomes of two trials comparing different procedures. One trial compared needle fasciotomy versus fasciectomy (125 hands, 121 participants), and the other compared interposition firebreak skin grafting versus z-plasty closure of fasciectomy (79 participants). The other 11 studies reported trials of technical refinements of procedures or rehabilitation adjuncts. Of these, three investigated effects of postoperative splinting on surgical outcomes. Ten studies (11 articles) were randomised controlled trials (RCTs) of varying methodological quality; one was a controlled clinical trial. Trial design was unclear in two studies awaiting classification. All trials had high or unclear risk of at least one type of bias. High risks of performance and detection bias were particularly common. We downgraded the quality of evidence (Grades of Recommendation, Assessment, Development and Evaluation-GRADE) of outcomes to low because of concerns about risk of bias and imprecision. Outcomes measured varied between studies. Five articles assessed recurrence; two defined this as reappearance of palpable disease and two as deterioration in angular deformity; one did not explicitly define recurrence. Hand function on the Disabilities of the Arm, Shoulder and Hand (DASH) Scale (scores between 0 and 100, with higher scores indicating greater impairment) was 5 points lower after needle fasciotomy than after fasciectomy at five weeks. Patient satisfaction was better after fasciotomy at six weeks, but the magnitude of effect was not specified. Fasciectomy improved contractures more effectively in severe disease: Mean percentage reduction in total passive extension deficit at six weeks for Tubiana grades I and II was 11% lower after needle fasciotomy than after fasciectomy, whereas for grades III and IV disease, it was 29% and 32% lower. Paraesthesia (defined as subjective tingling sensation without objective evidence of altered sensation) was more common than needle fasciotomy at one week after fasciectomy (228/1000 vs 67/1000), but reporting of complications was variable. By five years, satisfaction (on a scale from 0 to 10, with higher scores showing greater satisfaction) was 2.1/10 points higher in the fasciect...

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Recurrence after Surgery for Dupuytren’s Disease: A Randomized Trial of Two Skin Incisions

Cited by 57 publications

References 9 publications

A Systematic Review of Outcomes of Fasciotomy, Aponeurotomy, and Collagenase Treatments for Dupuytren's Contracture

A Systematic Review of Outcomes of Fasciotomy, Aponeurotomy, and Collagenase Treatments for Dupuytren's Contracture

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Surgery for Dupuytren's contracture of the fingers

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