Reply: Salvage Palmar Fasciectomy following Initial Treatment with Collagenase Clostridium Histolyticum.

METHODS • A retrospective review was performed from February 2010 to March 2014 • 11 patients identified who underwent complete palmar fasciectomy following at least one prior CCH injection • Cases reviewed for functional outcomes and operative difficulty RESULTS • 7 MCP and 12 PIP joints treated in 11 patients • Average interval between most recent CCH injection and salvage fasciectomy was 12 months • Intraoperative findings demonstrated disruption of normal tissue architecture and extensive scarring • Mean preand post-operative contractures for MP joints were 42 and 0 degrees; PIP joints 60 and 21 degrees CONCLUSIONS • CCH injection may produce extensive scarring and increase the difficulty of salvage fasciectomy • With careful technique, results of salvage fasciectomy may be similar to primary surgery Patient Characteristic Number Number of Patients 11 Mean Age (range, in years) 69 (52-76) Male Gender 6 Affected Hand Treated with Salvage Fasciectomy Left Only 0 Right Only 3 Bilateral 8 Joints Treated with Salvage Fasciectomy 19 Number of MCP Joints 7 Number of PIP Joints 12 Total Treated Joints/Patient (range) 1.7 (1-4) Treated PIP Joints/Patient (range) 1.1 (1-2) Treated MCP Joints/Patient (range) 0.64 (0-2) Prior Treatments for Dupuytren's Contracture CCH Injection 11 patients Mean Number of CCH Injections/Patient Before Fasciectomy (range) 1.5 (1-3) Mean Time Interval between CCH Injection and Fasciectomy (range)* 12 months (6-24)