Acta Chir Plast. 2020 Winter;62(3-4):60-63.
While injecting Clostridium Histolyticum as a non-surgical tratment for Dupuytrens disease on the palmar side of the hand the recommended depth of the needle should be “around 2 to 3 mm in depth”. The diffusion of CCH inside the soft tissues around the cord might explain the occurrence of common adverse events reported in the literature such as oedema, injection site swelling, blood blisters, skin laceration, and pain in extremity. We hypothesized that the injected Collagenase Clostridium Histolyticum does not only concentrate inside the cord but also dissipates both along the cord and into the adjacent tissues. This study investigated our hypothesis by visual intraoperative findings after injecting Povidone iodine into the cord.
Povidone iodine (PI)was injected into the cord on six patients with Dupuytrens contracture before an open surgical operation (partial fasciectomy). We marked three hypothetical Collagenase Clostridium Histolyticum injection points at 2 mm intervals on the skin above the cord around the metacarpo-phalangeal joint and the depth of the injection (distance from the skin surface to the middle of the cord) was measured by ultrasonography. After dispensing 0.25 ml of Povidone iodine into the three points at the measured depths, we performed careful dissection and investigated the extent of diffusion of Povidone iodine visually.
The injection depth averaged 2.6 mm. In all cases, the cord was homogenously stained about 10 mm along its extent centrally to the injected sites and infiltration of Povidone iodine into the subcutaneous structure and fat tissue occurred. Three cases showed diffusion into the neurovascular bundles and two cases showed infiltration underneath the cord structure.
This study simulated the likely diffusion outcomes of injected Collagenase Clostridium Histolyticum around the cord. This implies that even if Collagenase Clostridium Histolyticum is injected into the centre of the cord, it does not concentrate inside the cord only but also dissipates along the cord and infiltrates into the adjacent tissues with potential secondary damages.
在手部掌侧注射组织型纤溶酶原激活物（CCH）作为非手术治疗掌腱膜挛缩症时，推荐的进针深度为“约 2 至 3 毫米”。CCH 在索带周围软组织中的扩散可能解释了文献中报道的常见不良事件的发生，如水肿、注射部位肿胀、血疱、皮肤裂伤和肢体疼痛。我们假设，注射的胶原酶组织型纤溶酶原激活物不仅集中在索带内，而且还沿着索带和相邻组织消散。本研究通过在索带内注射聚维酮碘后的术中直观发现来验证我们的假设。
在 6 例掌腱膜挛缩症患者接受开放式手术（部分筋膜切开术）之前，将聚维酮碘（PI）注入索带内。我们在掌指关节周围索带上方的皮肤上标记三个假设的胶原酶组织型纤溶酶原激活物注射点，间隔 2 毫米，并通过超声测量每个点的注射深度（从皮肤表面到索带中间的距离）。在测量的深度向三点注射 0.25 毫升聚维酮碘后，我们仔细进行解剖并直观地研究聚维酮碘的扩散程度。
注射深度平均为 2.6 毫米。在所有病例中，索带在中央向注射部位延伸约 10 毫米处均匀染色，聚维酮碘渗透到皮下结构和脂肪组织中。三种情况显示扩散到神经血管束中，两种情况显示在索带结构下方渗透。
本研究模拟了注射到索带周围的胶原酶组织型纤溶酶原激活物的可能扩散结果。这意味着即使胶原酶组织型纤溶酶原激活物注射到索带中心，它也不会仅集中在索带内，而是沿着索带扩散并渗透到相邻组织中，从而产生潜在的继发性损伤。
