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Passiatore M, Cilli V, Cannella A, Caruso L, Sassara GM, Taccardo G, De Vitis R. Long-term assessment of collagenase treatment for Dupuytren's contracture: A 10-year follow-up study. World J Orthop 2024; 15:355-362. [PMID: 38680672 PMCID: PMC11045466 DOI: 10.5312/wjo.v15.i4.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/30/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Enzymatic fasciotomy with collagenase clostridium histolyticum (CCH) has revolutionized the treatment for Dupuytren's contracture (DC). Despite its benefits, the long-term outcomes remain unclear. This study presented a comprehensive 10-year follow-up assessment of the enduring effects of CCH on patients with DC. AIM To compare the short-term (12 wk) and long-term (10 years) outcomes on CCH treatment in patients with DC. METHODS A cohort of 45 patients was treated with CCH at the metacarpophalangeal (MCP) joint and the proximal interphalangeal (PIP) joint and underwent systematic re-evaluation. The study adhered to multicenter trial protocols, and assessments were conducted at 12 wk, 7 years, and 10 years post-surgery. RESULTS Thirty-seven patients completed the 10-year follow-up. At 10 years, patients treated at the PIP joint exhibited a 100% recurrence. However, patients treated at the MCP joint only showed a 50% recurrence. Patient satisfaction varied, with a lower satisfaction reported in PIP joint cases. Recurrence exceeding 20 degrees on the total passive extension deficit was observed, indicating a challenge for sustained efficacy. Significant differences were noted between outcomes at the 7-year and 10-year intervals. CONCLUSION CCH demonstrated sustained efficacy when applied to the MCP joint. However, caution is warranted for CCH treatment at the PIP joint due to a high level of recurrence and low patient satisfaction. Re-intervention is needed within a decade of treatment.
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Affiliation(s)
- Marco Passiatore
- Department of Bone and Joint Surgery, ASST-Spedali Civili, Brescia 25123, Italy
| | - Vitale Cilli
- Department of Chirurgie de la Main, Centre Hospitalier Interregional Edith Cavell, Bruxelles 1160, Belgium
| | - Adriano Cannella
- Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome 00168, Italy
| | - Ludovico Caruso
- Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome 00168, Italy
| | - Giulia Maria Sassara
- Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome 00168, Italy
| | - Giuseppe Taccardo
- Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome 00168, Italy
| | - Rocco De Vitis
- Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome 00168, Italy
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Alhebshi ZA, Bamuqabel AO, Alqurain Z, Dahlan D, Wasaya HI, Al Saedi ZS, Alqarni GS, Alqarni D, Ghalimah B. Comparing Complications and Patient Satisfaction Following Injectable Collagenase Versus Limited Fasciectomy for Dupuytren's Disease: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e53147. [PMID: 38420076 PMCID: PMC10900279 DOI: 10.7759/cureus.53147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Dupuytren's disease (DD) is a fibroproliferative disorder that manifests as an abnormal growth of myofibroblasts, causing nodule formation and contractures and affecting digit function. If left untreated, these contractures can lead to a loss of mobility and potentially impact hand function. This systematic review critically compares and evaluates the existing literature on the complications and patient satisfaction following injectable collagenase Clostridium histolyticum (CCH) versus limited fasciectomy (LF) for DD. We performed a comprehensive search of the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), The Cochrane Library, and Excerpta Medica database (EMBASE) databases from 2006 to August 2023. This research targeted all clinical studies involving adults who underwent injectable collagenase and/or limited fasciectomy in the management of DD. Out of the 437 identified studies, only 53 were considered eligible for our analysis, and merely 14 met our inclusion criteria. These selected studies encompassed a total of 967 patients with 1,344 treated joints, with an average follow-up duration of 19.22 (ranging from one to 84.06) months. Within this cohort, 498 joints from 385 patients underwent LF, while 846 joints from 491 patients received CCH injections. Notably, among the 491 patients treated with CCH, 1,060 complications were reported, averaging 2.15 complications per patient, with the most common being contusion/bruising/hematoma/ecchymosis (22.54%), and edema/swelling (18.96%). In contrast, among the 385 patients treated with LF, only 97 complications were reported, translating to 0.25 complications per patient, with the most frequent being paraesthesia or numbness (23.7%), scar sequelae like skin laceration, tear, fissure, or hypertrophic scar (23.7%), and neuropraxia or nerve injury (22.6%). Our meta-analysis indicates that paraesthesia or numbness is more frequently observed in LF than CCH injections, although without statistical significance, with a risk ratio (RR) of 0.39 (95% confidence interval (CI) 0.13-1.18, p-value 0.1). However, scar sequelae (hypertrophic scar, skin laceration, tear, or fissure) show a contrasting pattern, being more commonly associated with CCH injections than LF, with an RR of 1.98 (95% CI 0.26-14.85, p-value 0.51), which, upon eliminating the source of heterogeneity, becomes statistically significant, with an RR of 4.98 (95% CI 1.40-17.72, p-value 0.01). Our data revealed a higher frequency of complications with CCH compared to LF, although more severe adverse effects were observed in the LF group, such as neuropraxia or nerve injury. Scar sequelae were more common with CCH injections. Despite both treatments showing increased patient satisfaction at the final follow-up, CCH injection resulted in earlier improvements in satisfaction.
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Affiliation(s)
- Zainah A Alhebshi
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Aya O Bamuqabel
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Zainab Alqurain
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Dana Dahlan
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Hanan I Wasaya
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Ziyad S Al Saedi
- College of Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Gutaybah S Alqarni
- College of Medicine, Faculty of Medicine, University of Jeddah, Jeddah, SAU
| | - Danah Alqarni
- College of Medicine and Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Bayan Ghalimah
- Department of Orthopaedic Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Nordenskjöld J, Nilsson J, Kalaf R, Atroshi I. Delayed vascular complication after collagenase injection for Dupuytren disease. BMC Musculoskelet Disord 2023; 24:837. [PMID: 37872560 PMCID: PMC10594859 DOI: 10.1186/s12891-023-06964-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Vascular adverse events after collagenase injection for Dupuytren disease are absent in large trials and systematic reviews. The aim of this study is to present a case series of delayed vascular complications after collagenase treatment. METHODS A prospective evaluation of 1181 consecutively treated patients at one orthopedic department identified three patients reporting symptoms of possible vascular complication. Baseline demographics and description of symptoms were collected, with a physical examination documenting extension deficit and neurovascular status. All patients completed the Cold Intolerance Symptom Severity (CISS) scale (range 4-100, lower is better) and underwent Doppler sonography examination of the digital arteries. RESULTS All patients were treated in the small finger and two had an isolated proximal interphalangeal joint contracture. All patients had a delayed presentation of a few months, with episodes of white discoloration of the treated finger relieved within 30 min and associated with variable pain, paresthesia, stiffness and weakness. Two of the patients reported cold exposure as an episode trigger and had a pathological CISS score (40 and 36, respectively). Doppler sonography identified a nonpatent ulnar digital artery in one patient. CONCLUSIONS Delayed vascular complication after collagenase treatment is rare, but surgeons and patients should be aware of the risk, especially when treating the small finger.
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Affiliation(s)
- Jesper Nordenskjöld
- Department of Orthopedics, Hässleholm- Kristianstad Hospitals, Hässleholm, Sweden.
- Department of Clinical Sciences- Orthopedics, Lund University, Lund, Sweden.
| | - Jonas Nilsson
- Department of Radiology, Kristianstad Hospital, Kristianstad, Sweden
| | - Roua Kalaf
- Department of Radiology, Kristianstad Hospital, Kristianstad, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Hässleholm- Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences- Orthopedics, Lund University, Lund, Sweden
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Taccardo G, Cilli V. Collagenase and Dupuytren's disease: Where are we in 2022 and in what way should we go? J Plast Reconstr Aesthet Surg 2023; 76:268. [PMID: 36538865 DOI: 10.1016/j.bjps.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Giuseppe Taccardo
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, 00168, Italy.
| | - Vitale Cilli
- Chirurgie de la main, CHIREC site Delta, Bruxelles, Belgium
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DE VITIS R, PASSIATORE M, PERNA A, CILLI V, PONZO I, TACCARDO G. Does the Use of Gelled Platelet-Rich Plasma during Fixation of Subacute Proximal Pole Scaphoid Fractures Help? – A Single Centre Experience. J Hand Surg Asian Pac Vol 2022; 27:615-622. [DOI: 10.1142/s2424835522500588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Subacute proximal pole scaphoid fractures (1 month to 6 months) have a higher risk of non-union. The aim of the present retrospective analysis is to evaluate the efficacy of gelled platelet-rich plasma (GPRP) as additional treatment to antegrade headless screw fixation of proximal pole scaphoid fractures. Methods: Forty-one patients were divided into two groups based on surgical treatment received: screw fixation alone (group A) and screw fixation and GPRP application at the fracture site (group B). A short cast was maintained for 4 weeks after surgery. Outcome measures included time to union, need for additional procedures, time to return to work, disabilities of the arm, shoulder, and hand (DASH) questionnaire, Michigan Hand Questionnaire (MHQ) and Mayo wrist score (MWS).Time to union was determined by monthly radiographs and confirmed by a computerized tomographic (CT) scan done at 4 months. Results: Union was achieved in 85.7% of patients in group A and in 100% of patients in group B. Patients in group B showed a faster time to healing (2.3 ± 0.4 months vs 3.1 ± 0.7 months, p = 0.0001) and earlier return to work (10.4 ± 2.2 vs 15.1 ± 2.9, p = 0.0001). There were no significant differences in patient-rated outcomes scores between the two groups at final follow-up. Conclusions: Internal fixation alone is effective in treating subacute proximal pole scaphoid fractures. GPRP application improves bone healing and functional recovery. Level of Evidence: Level III (Therapeutic)
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Affiliation(s)
- Rocco DE VITIS
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco PASSIATORE
- Unit of Orthopedics and Traumatology 2, Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Andrea PERNA
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vitale CILLI
- Hand Surgery Unit, CHIREC Site Delta, Bruxelles, Belgium
| | - Ida PONZO
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe TACCARDO
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2687-2697. [PMID: 34378143 PMCID: PMC8514382 DOI: 10.1007/s00264-021-05153-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.
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Horch RE, Schmitz M, Kreuzer M, Arkudas A, Ludolph I, Müller-Seubert W. External Screw-Threaded Traction Device Helps Optimize Finger Joint Mobility in Severe Stage III and IV Dupuytren Disease. Med Sci Monit 2021; 27:e929814. [PMID: 33883543 PMCID: PMC8078024 DOI: 10.12659/msm.929814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Treating advanced finger joint contractures from Dupuytren disease remains a challenge. We evaluated the effectiveness of a skeletal distraction device versus alternative treatment options. Material/Methods We analyzed the surgical treatment of contracted finger joints in stage III and stage IV Dupuytren’s disease over a 10-year period. Data were obtained from inpatient and outpatient medical records, including postoperative clinical examinations and extended Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores. Complications of infection, postoperative pain, and wound healing disorders were recorded. Results A total of 79 patients (83 hands) were assigned to 2 treatment groups. Patients in group 1 underwent an initial open transection of the main fibrous cord, Z-plasty, distraction with the Erlangen external distraction device, and fasciectomy. The distraction period was 13 to 81 days (mean 31 days). Group 2 underwent a conventional single-stage fasciectomy and arthrolysis. DASH scores and subjective patient satisfaction were lower in group 1 (20.7/33%) than in group 2 (10.3/50%). However, the staged approach of group 1 to treat proximal interphalangeal joint contractures in the long term (improvement >40%) was more effective than the approach of group 2 (>33%). Distraction device pin infections occurred in 20% of hands. Postoperative pain and complex regional pain syndrome type I occurred in 25% of hands in group 1 and 3% in group 2. Conclusions A screw thread driven external fixation device is useful in end-stage Dupuytren’s finger joint contractures. It is indicated when joint contractures are advanced and simple arthrolysis is insufficient.
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Affiliation(s)
- Raymund E Horch
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marweh Schmitz
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Maria Kreuzer
- Department of Geriatric Medicine, Klinikum St. Marien Amberg, Amberg, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Wibke Müller-Seubert
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Cilli V. Dupuytren's disease treatment during the second wave of COVID-19 pandemic. J Plast Reconstr Aesthet Surg 2020; 74:644-710. [PMID: 33390345 PMCID: PMC7834312 DOI: 10.1016/j.bjps.2020.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Vitale Cilli
- Centre Hospitalier Interregional Edith Cavell, Bruxelles, Belgium.
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Vigliarolo D. COVID-19 and hand surgery: the perspective of an Italian hand therapist. HAND SURGERY & REHABILITATION 2020; 40:208. [PMID: 33309982 PMCID: PMC7728422 DOI: 10.1016/j.hansur.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/22/2020] [Accepted: 11/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- D Vigliarolo
- Hand Therapy Service, Policlinico Gemelli Foundation, Largo Agostino Gemelli, 8, 00168 Roma RM, Italy.
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Cilli V. Alternative Strategies of Home Therapy in Clinical Orthopaedics during COVID-19 Pandemic: a Hand Surgeon Perspective. Malays Orthop J 2020; 14:154-155. [PMID: 32983395 PMCID: PMC7513661 DOI: 10.5704/moj.2007.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- V Cilli
- Hand Surgery, Chirec Site Delta, Brussels, Belgium
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De Vitis R, Passiatore M, Cilli V, Lazzerini A, Marzella L, Taccardo G. Feasibility of Homodigital Flexor Digitorum Superficialis transposition, a new technique for A2-C1 pulleys reconstruction: A kinematic cadaver study. J Orthop 2020; 21:483-486. [PMID: 32982105 PMCID: PMC7498708 DOI: 10.1016/j.jor.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/06/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Homodigital flexor digitorum superficialis transposition (HFT) is proposed as a new technique for A2-C1 pulley reconstruction. Flexor digitorum superficialis is transposed on the proximal phalanx and inserted on the pulley rims, crossing over flexor digitorum profundus and acting as a pulley. MATERIALS AND METHODS The kinematic feasibility was investigated in a cadaveric bowstring model (after A2 and C1 pulley removal) on 22 fingers (thumb excluded). RESULTS HFT was effective in restoring the correct flexion of proximal and distal interphalangeal joints, compared to bowstring model. No adverse events were registered. CONCLUSION HFT is a feasible technique. Clinical application is encouraged.
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Affiliation(s)
- Rocco De Vitis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Istituto di Clinica Ortopedica, Roma, Italy
| | - Marco Passiatore
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Clinica Ortopedica, Italy
| | - Vitale Cilli
- Chirurgie de La Main, CHIREC Site Delta, Bruxelles, Belgium
| | | | | | - Giuseppe Taccardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Istituto di Clinica Ortopedica, Roma, Italy
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Passiatore M, De Vitis R, Taccardo G. Xiapex™ will no longer be distributed in Europe: Our concerns and our hopes relative to collagenase. HAND SURGERY & REHABILITATION 2020; 39:466. [PMID: 32376510 DOI: 10.1016/j.hansur.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Passiatore
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Unità Operativa Complessa di Chirurgia della mano, Largo Agostino Gemelli, 8, 00168 Roma, Italia.
| | - R De Vitis
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Unità Operativa Complessa di Chirurgia della mano, Largo Agostino Gemelli, 8, 00168 Roma, Italia; Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Roma, Italia.
| | - G Taccardo
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Unità Operativa Complessa di Chirurgia della mano, Largo Agostino Gemelli, 8, 00168 Roma, Italia; Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Roma, Italia.
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