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Treatments for Digital Ulcers: Surgical

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
Amputation
Digital Sympathectomy
Peripheral Arterial Bypass
Wound Care Centers

Overview of Surgical Treatment of Digital Ulcers

"If it has not started healing in a month, it's not healing — it's getting worse!"

Digital (finger, toe) ulcers can occur in patients who have either limited or diffuse systemic sclerosis (SSc), which is also known simply as scleroderma (SD) and frequently even abbreviated as "sclero". Surgical treatments include amputation of the affected area, digital sympathectomies, and peripheral arterial bypass grafts. (Also see Overview of Digital Ulcers, What is Scleroderma? and Types of Scleroderma)

Peripheral arterial- bypass grafts in the hand or foot in systemic sclerosis. Following successful vascular reconstruction on two adult patients, digital temperatures, pain and cold sensitivity and health-related quality of life improved significantly. No recurrence has been encountered after X and Y months of follow-up. Kwon ST. (PubMed) J Plast Reconstr Aesthet Surg. 2009 Jul;62(7):e216-21.

Amputation

Gangrene (Death of Tissue) and Amputation. Digital ulcers can develop gangrene and lead to amputation. Thus Raynaud's prevention and prompt and careful treatment of digital ulcers is absolutely essential. ISN.

Prevention of amputation caused by rheumatic diseases following a novel therapy of exposing bone marrow, occlusive dressing and subsequent epidermal grafting. Exposure of bone marrow cells plus an occlusive dressing accelerates the healing of skin ulcers. PubMed, Br J Dermatol. 2005 Apr;152(4):664-72. (Also see Gangrene and Amputation)

Ulnar artery vasculopathy in systemic sclerosis. It is suggested that angiographic screening and early surgical intervention such as revascularization should be considered in patients with systemic sclerosis who manifest a severe form of Raynaud's phenomenon and/or digital ulceration and especially in patients with diffuse sclerosis. Jeong Ha Park. Rheumatology International. April 12, 2009. (Also see Raynaud's)

Digital Sympathectomy

Digital Sympathectomy (Microvascular Hand Surgery). Severe cases of Raynaud's should be managed by the rheumatologist, where treatments may include vascular and hand surgery. ISN.

Peripheral Arterial Bypass Grafts in Systemic Sclerosis

Peripheral arterial- bypass grafts in the hand or foot in systemic sclerosis. Following successful vascular reconstruction on two adult patients, digital temperatures, pain and cold sensitivity and health-related quality of life improved significantly. No recurrence has been encountered after X and Y months of follow-up. Kwon ST. (PubMed) J Plast Reconstr Aesthet Surg. 2009 Jul;62(7):e216-21.

Wound Care Centers

Wound healing after hand surgery in patients with systemic sclerosis-a retrospective analysis of 41 operations in 19 patients. In systemic sclerosis, surgery performed electively does not seem to have increased difficulty with wound healing. Even larger operations, such as wrist arthrodesis or wrist replacement, can be performed safely. PubMed, J Hand Surg [Br]. 2007 Feb 1. (Also see Raynaud's Treatments)

Many times Scleroderma skin ulcers are treated at wound care centers. Follow your doctor's advice carefully for healing wounds. And remember this rule of thumb:

"If it has not started healing in a month, it's not healing — it's getting worse!"
Go to Topical Treatments for Digital Ulcers
 
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