High-Speed Burr Debulking of Digital Calcinosis Cutis in Scleroderma Patients

Lapner, Michael; Goetz, Thomas J.

doi:10.1016/j.jhsa.2013.12.003

Cited by 14 publications

(5 citation statements)

References 22 publications

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“…By contrast, only 7 out of 19 patients, having only pharmaceutical treatment, showed any reponse [35]. Special methods, such as a curettage of calcinosis foci [66] or cytoreduction with a high-frequency microdrill [67], effectively reduced painful sensations and disability of calcinosis patients; however, lesions tended to recur.…”

Section: Methodsmentioning

confidence: 99%

Кальциноз При Системній Склеродермії: Поширеність, Клініка, Менеджмент, Ускладнення

Yehudіna¹,

Golovach²

2021

PJS

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This literature review summarizes current data on the epi demiology, pathophysiology, diagnosis and treatment of calcinosis cutis in patients with systemic sclerosis (SSc). The article deals with the analysis of observational studies of the frequency of calcinosis in SSc and associated clinical features, molecular research of potential pathogenetic mechanisms, clinical cases describing new diagnostic approaches and methods for the treatment of calcinosis. Calcinosis cutis is the deposition of insoluble calcium in the skin and subcutaneous tissues. Calcinosis is one of the main, poorly managed clinical problems in patients with SSc, affecting at least one quarter of patients with SSc. Calcinosis is associated with a longer disease duration, digital ulcers, acro-osteolysis, positive anticentromere and anti-topoisomerase antibodies. Although the pathogenesis of calcification is not fully known, there is evidence supporting the role of local chronic traumatization, chronic inflammation, vascular hypoxia and malregulation of bone matrix proteins as potential mechanisms for the development of this pathological condition in patients with SSc. The diagnosis can be established on the basis of clinical data or using plain X-ray. Several pharmacolo gical treatment methods have been applied in patients with calcinosis with variable and not so significant results; in turn, surgical excision of calcium deposits remains mainstay of treatment.

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Section: Methodsmentioning

confidence: 99%

Кальциноз При Системній Склеродермії: Поширеність, Клініка, Менеджмент, Ускладнення

Yehudіna¹,

Golovach²

2021

PJS

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“…Calcinosis has been treated using a high-speed burr procedure in which small stab incisions are made through which calcium deposits are burred and extruded with saline. 8 Lapner and Goetz 8 suggest that the high-speed burr technique should be reserved for focal calcinosis limited to 1 or 2 fingers. Finally, carbon dioxide laser therapy has been used to vaporize calcium deposits with moderate resolution of pain, although results show limited success.…”

Section: Calcinosismentioning

confidence: 99%

Considerations for Hand Surgery in Patients With Scleroderma

Brown

Crouser

Speeckaert

2021

Hand (New York, N,Y.)

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Systemic sclerosis (scleroderma, SSc) is an autoimmune disease that causes significant dysfunction to multiple organ systems, including the musculoskeletal system. It poses significant challenges to the hand surgeon, including calcinosis, ischemic changes, Raynaud phenomenon, tendinopathies, synovitis, and joint contractures. Patients with SSc also suffer from multiorgan dysfunction, which makes them high-risk surgical patients. The hand surgeon must understand the pathophysiology, treatment strategies, and special operative considerations required in this population to avoid complications and help maintain or improve hand function.

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“…Debulking has also been performed using a high-speed bur through smaller stab incisions. 6 Outcome studies have been limited to case reports and small case series and have shown that many but not all patients have a good response to the procedure. 2,6 Some authors have advocated for radical excision of calcifications and flap reconstruction where necessary.…”

Section: Calcinosismentioning

confidence: 99%

“…6 Outcome studies have been limited to case reports and small case series and have shown that many but not all patients have a good response to the procedure. 2,6 Some authors have advocated for radical excision of calcifications and flap reconstruction where necessary. However, in our and others' experience, the risks of radical excision outweigh the benefits because it is unnecessary for symptomatic relief and the extensive soft tissue dissection entailed often results in severe tissue loss and scarring in these patients.…”

Section: Calcinosismentioning

confidence: 99%

The Scleroderma Hand: Manifestations of Disease and Approach to Management

Williams

Carl

Lifchez

2018

The Journal of Hand Surgery

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Scleroderma is a rare autoimmune connective tissue disorder that often affects the hands. Manifestations in the hands include calcium deposits within the soft tissues that cause pain and may ulcerate through the skin, digital ischemia resulting in chronic wounds and digital gangrene, and joint contracture. Because of the underlying disease, patients with scleroderma have poorly vascularized tissue and a deficient soft tissue envelope, which make surgery particularly challenging. However, when undertaken with care, surgical intervention is often the best option for addressing the disabling hand conditions that so often accompany this disease.

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High-Speed Burr Debulking of Digital Calcinosis Cutis in Scleroderma Patients

Cited by 14 publications

References 22 publications

Кальциноз При Системній Склеродермії: Поширеність, Клініка, Менеджмент, Ускладнення

Кальциноз При Системній Склеродермії: Поширеність, Клініка, Менеджмент, Ускладнення

Considerations for Hand Surgery in Patients With Scleroderma

The Scleroderma Hand: Manifestations of Disease and Approach to Management

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