REVIEW population is a potentially heterogeneous population and thus, standardizing wound care protocols is crucial. Furthermore, it is important to standardize DU outcome measures, for example, assessments of healing and development of new lesions, during the design phase of DU clinical trials. In general, there is a paucity of evidence on the wound care for managing SSc patients. The purpose of this manuscript is to review the current recommendations for local wound management in patients with ulcerations, which we believe to be applicable to digital ulcers. The overarching goal is to develop recommendations for local wound care for SSc-associated DUs that might be a useful starting point for future clinical trial design. Role of tissue perfusion in digital ulcer healing The importance of local wound perfusion in both SScrelated DU development and healing has been demonstrated by flow-mediated dilatation, laser Doppler imaging (LDI) and thermography (12-14). An increase in DU perfusion correlates with healing, and LDI has successfully been implemented as an outcome measure in a clinical trial (15). Similarly, a study investigating power Doppler ultrasonography found that ulnar artery occlusion was a predictor of new or recurrent DUs in patients with SSc (16). Thus, documentation of adequate perfusion by noninvasive measures of blood flow is an important initial step for DU evaluation and may be used both for assessment of severity of vasculopathy as well as likely responsiveness to vasoactive treatments (17).