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Treatments for Digital Ulcers: Surgical

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
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)

Digital ulcer debridement in systemic sclerosis: a systematic literature review. A standardized protocol and randomized controlled trials are needed to demonstrate debridement the safety and efficacy of digital ulcer debridement in systemic sclerosis. PubMed, Clin Rheumatol, 2020 Mar;39(3):805-811.


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.

Case Report: Acute Hand Ischemia and Digital Amputation After Transradial Coronary Intervention in a Patient With CREST Syndrome. This report focuses on a case of radial artery occlusion after percutaneous coronary intervention in a 46-year-old woman with CREST syndrome, which ultimately led to acute hand ischemia necessitating amputation of her middle and index fingers. PubMed, Tex Heart Inst J.

Ulnar Artery Occlusion (UAO) and Severity Markers of Vasculopathy in Systemic Sclerosis (SSc): A Multicenter Cross-Sectional Study. UAO may represent a relevant severity marker of vasculopathy in SSc. PubMed, Arthritis Rheumatol, 2019 Jun;71(6):983-990.

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

Case Report: 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. PubMed, J Plast Reconstr Aesthet Surg.

Wound Care Centers

TOP-N53: A Clinical Drug Candidate for the Treatment of Non-healing Wounds. The promising first drug candidate TOP-N53 is currently in early clinical development. PubMed, Chimia (Aarau), 2020 Oct 28;74(10):814-817.

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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