Surgical management of the hand in scleroderma

Disabling deformity of the hand is a hallmark feature of the person afflicted with scleroderma. However, existing literature provides little guidance to operative treatment for the wide spectrum of hand derangement. Although arthrodesis is generally recommended for severe flexion contractures of the interphalangeal joints, other surgical procedures such as arthroplasty, excision of painful calcinosis, and digital sympathectomy have been employed sparingly, undoubtedly due to potentially hazardous soft tissue conditions. Based on experience with 70 scleroderma patients requiring 272 hand operations, this article provides further insight as to the role of surgical treatment for the scleroderma hand. The favorable results in this relatively large series of cases support the efficacy of precisely timed and skillfully executed surgery in the alleviation of pain, prevention of tissue loss, preservation of function, and improvement in aesthetics. For the ischemic tissues of the scleroderma hand the prerequisite for uncomplicated surgery is a tension-free wound, often requiring judicious skeletal shortening and healing by secondary intention.