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Management of finger ulcers in scleroderma
1Miller Orthopaedic Clinic, Department of Radiology, Charlotte, NC 28203, USA.
The Journal of Hand Surgery
|September 1, 1995
Summary
Digital sympathectomy effectively treats chronic digital ulcers in scleroderma patients unresponsive to conservative care. This surgical intervention offers long-term healing for nonhealing ulcers, improving patient outcomes.
Area of Science:
- Vascular Surgery
- Rheumatology
- Dermatology
Background:
- Scleroderma commonly causes chronic, nonhealing digital ulcers due to vaso-occlusive disease.
- Nonoperative management often fails to resolve these debilitating ulcerations.
Purpose of the Study:
- To evaluate the efficacy of nonoperative and operative treatments for digital ulcers in scleroderma patients.
- To determine the long-term outcomes of digital sympathectomy for refractory digital ulcers.
Main Methods:
- Twelve patients (15 hands) with scleroderma and chronic digital ulcers were treated.
- Initial management included nifedipine, biofeedback, xylocaine blockade, topical silver sulfadiazine, and cessation of vasoconstrictors.
- Patients failing nonoperative treatment underwent palmar digital sympathectomy.
Main Results:
- Nonoperative treatment resulted in healing in 6 of 15 hands.
- Seven patients with nine hands proceeded to digital sympathectomy, with ulcer healing within 6 weeks post-surgery.
- At 26-64 month follow-up, 6 of 9 sympathectomized hands remained ulcer-free; 3 had partial recurrence.
Conclusions:
- Digital sympathectomy is an effective treatment for nonhealing digital ulcers in scleroderma patients when nonoperative measures fail.
- Vaso-occlusive disease is a significant factor in these patients.
- A stepwise approach, including conservative measures followed by sympathectomy, is recommended.