DOS Kongressen 2014 ·
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Skin tear correlates to the degree of contracture when
treated for Dupuytrens contracture with Xiapex
Christian Fagernæs, Susanne Mallet
Orthopaedics, Køge Hospital
Background:
Xiapex is used in the treatment of Dupuytren’s disease (DD).
Xiapex is injected into the cord which the next day is manipulated to attempt
rupture. No trial has explored the number of skin tear as an adverse effect
(AE).
Purpose / Aim of Study:
The aim was to explore the joint level and the degree
of contracture to the risk of the AE of skin tear.
Materials and Methods:
105 cases (90 patients) with DD with DIP and/or PIP
contracture from august 1st 2012 till april 1st 2014 were enrolled prospec-
tively. Excisting skin defects were cause for exclusion. DIP and PIP contractures
were treated with 0.25 mL and 0.20 mL of Xiapex .The degree of contracture
was measured with a goniometer and skin tears were classified as yes/no.
Findings / Results:
77 (73%) had the contracted cord at the level of the MCP
joint and 28 (27%) at the level of the PIP joint. 59 (56%) got skin tear. The RR
of skin tear is 1,5 for MCP level of >60 degrees compared to MCP level at 20-
59 degrees (p=0,17). The RR of skin tear is 2,2 for PIP level of >60 degrees
compared to PIP level at 20-59 degrees (p=0,04). The relative risk for skin tear
is 1,1 (CI = (0.72; 1.58), p=0,74) for MCP level compared to PIP level. By logis-
tic regression it is shown that the degree is the most important factor concern-
ing skin tear with a higher risk in the >60 degree-group compared to the 20-59
degree-group with an odds ratio of 5.4 ((95%CI (1.4; 20.6), p=0.01).
Conclusions:
There is a higher risk of skin tear when the contracture is >60 de-
gree and located at the level of the PIP joint. Overall the factor most important
for higher risk of skin tear is the degree of the contracture more that the level.
Focus on patients with contracture of more than 60 degrees is needed. A type
of skin-softener could be helpful but should be explored.
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