COLLAGENASE IN THE TREATMENT OF DUPUYTRENS DISEASE - AN IN-VITRO STUDY

The effects of clostridial collagenase on the tensile strength of Dupu ytren's cords was studied in vitro to assess its potential efficacy as an agent for clinical enzymatic fasciotomy. Collagenase was injected into Dupuytren's cords from patients undergoing fasciectomy, Following a pilot experiment, in which a 3,600-unit dose of collagenase induced a 93% decrease in tensile modulus as compared with control cords, gro ups of five cords each were injected with 150, 300, and 600 units. The se cords and a control group of five cords were tested by loading to f ailure in tension. The ultimate stress and strain to failure were reco rded by a video capture technique. All specimens were stained for hist ologic examination with hematoxylin and eosin and for collagen typing with sirrius red. Comparison of the ultimate stress values obtained wi th published values of extensor forces obtainable by the individual fi ngers of 40 normal hands indicated that a 300-unit dose of collagenase was sufficient for cord rupture within the average maximum force limi ts of the extensors of the index, long, ring, and small fingers (p < . 02). All samples were in the residual disease stage histologically and contained type I collagen by sirrius red staining. These results indi cate that collagenase may be effective in enzymatic fasciotomy of resi dual-stage Dupuytren's disease.