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Dupuytren's disease treatment during the second wave of COVID-19 pandemic

Published:December 17, 2020DOI:https://doi.org/10.1016/j.bjps.2020.12.030
      I have read with interest the article entitled “Percutaneous needle fasciotomy for Dupuytren's disease: A one-stop approach incidentally suited to the era of COVID-19″ by Patel and Patel.
      • Patel M.I.
      • Patel I.A.
      Percutaneous needle fasciotomy for Dupuytren's disease: a one-stop approach incidentally suited to the era of COVID-19.
      In Europe we are within the “second pandemic wave” and we will be unable to comply with the patients’ requests for elective surgery.
      • De Vitis R.
      • Passiatore M.
      • Perna A.
      • Proietti L.
      • Taccardo G
      COVID-19 contagion and contamination through hands of trauma patients: what risks and what precautions?.
      I am gradually adapting to the percutaneous needle fasciotomy, as suggested by Patel and Patel.
      • Patel M.I.
      • Patel I.A.
      Percutaneous needle fasciotomy for Dupuytren's disease: a one-stop approach incidentally suited to the era of COVID-19.
      However, by practicing it, I noticed that it is not always that simple, requiring specific technical skills, especially at the inter-phalangeal joint. Furthermore, needle fasciotomy is not devoid of any complications and is associated with recurrence.
      • Zachrisson A.
      • Sörensen A.I.
      • Strömberg J
      Needle fasciotomy for Dupuytren's contracture- a prospective cohort study of 58 fingers with a median follow-up of 6.5 years.
      Considering that there is still no definitive solution today for Dupuytren's disease, in this moment more than ever, I would prefer to use collagenase injections, a safe and useful technique in which I confide.
      • De Vitis R.
      • Passiatore M.
      • Perna A.
      • Careri S.
      • Cilli V.
      • Taccardo G
      Seven-year clinical outcomes after collagenase injection in patients with Dupuytren's disease: a prospective study.
      Many patients are asking me for collagenase injections now more than ever, asking for an outpatient surgery treatment. Many of them prefer collagenase injections to other techniques, considering their previous successful experiences. Unfortunately, Collagenase from Clostridium Histoliticum is no longer available in Europe, due to the withdrawal of the drug from the European market. Collagenase was a valid option from which both patients and surgeons could choose, based on their personal experiences. The current situation requires us to adapt to percutaneous needle fasciotomy. Nevertheless, the need for mini-invasive therapies, resulting from the current situation, stresses the importance of collagenase as a precious drug, not just in the context of hand disease. Both patients and surgeons cannot be deprived of it. I hope in the re-release of collagenase into the market and/or to succeed in finding a new permanent non purely surgical solution for Dupuytren's disease, according to Hueston's dream: “I have a dream that one day Dupuytren's disease will be treated without surgery”.
      • Hueston J.
      Lessons in Dupuytren's disease.
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      References

        • Patel M.I.
        • Patel I.A.
        Percutaneous needle fasciotomy for Dupuytren's disease: a one-stop approach incidentally suited to the era of COVID-19.
        J Plast Reconstr Aesthet Surg : JPRAS. 2020; 73: 2086-2102
        • De Vitis R.
        • Passiatore M.
        • Perna A.
        • Proietti L.
        • Taccardo G
        COVID-19 contagion and contamination through hands of trauma patients: what risks and what precautions?.
        J Hosp Infect. 2020; 105: 354-355
        • Zachrisson A.
        • Sörensen A.I.
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        Needle fasciotomy for Dupuytren's contracture- a prospective cohort study of 58 fingers with a median follow-up of 6.5 years.
        J Plast Surg Hand Surg. 2020; 54: 89-93
        • De Vitis R.
        • Passiatore M.
        • Perna A.
        • Careri S.
        • Cilli V.
        • Taccardo G
        Seven-year clinical outcomes after collagenase injection in patients with Dupuytren's disease: a prospective study.
        J Orthop. 2020; 21: 218-222
        • Hueston J.
        Lessons in Dupuytren's disease.
        Ann Chir la main du Memb Super organe Off des Soc Chir la main = Ann hand Up limb Surg. 1992; 11: 349-354

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