Management of sclerodermal finger ulcers

Gahhos, Fivos N.; Ariyan, Stephan; Frazier, William H.; Cuono, Charles B.

doi:10.1016/s0363-5023(84)80216-6

Cited by 30 publications

(20 citation statements)

References 28 publications

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“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] There were no randomized controlled trials. One study was randomized but lacked a control group.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies mentioned the number of patients included but did not indicate the total number of procedures, and we assumed all procedures were unilateral. [11][12][13] Five articles described the outcomes for the total of patients, rather than procedures. If conversion to the total of procedures was impossible, we assumed that they were all unilateral.…”

Section: Discussionmentioning

confidence: 99%

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Thoracic sympathectomy for digital ischemia: A summary of evidence

Coveliers

Hoexum

Nederhoed

et al. 2011

Journal of Vascular Surgery

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“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] There were no randomized controlled trials. One study was randomized but lacked a control group.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thoracic sympathectomy for digital ischemia: A summary of evidence

Coveliers

Hoexum

Nederhoed

et al. 2011

Journal of Vascular Surgery

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“…If the ulcer appeared superficial without exposed bone or deep infection, debridement was performed (three digits); otherwise amputation was performed as definitive treatment (seven digits). 19 All patients required narcotic analgesics preoperatively. Five patients were on vasodilator medications at the time of surgery.…”

Section: Methodsmentioning

confidence: 99%

Surgery for ischemic pain and Raynaud's' phenomenon in scleroderma: A description of treatment protocol and evaluation of results

2001

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Although the literature suggests that palmar sympathectomy (PS) with or without vascular reconstruction may improve ischemic digital pain, fingertip ulceration, and cold intolerance in patients with scleroderma, the question regarding long-term efficacy still remains. This retrospective study of six patients (eight hands) operated on between 1995 and 1997 evaluates both early (6 months) and long-term (average, 2.5 years) outcome after PS in combination with decompression arteriolysis of the radial and ulnar arteries proximal to the wrist. When preoperative digital blood flow was inadequate based on noninvasive vascular studies and major inflow occlusion was present, vascular reconstruction was also performed when feasible. At early review, significant improvement in ischemic digital pain and moderate improvement in cold intolerance resulted in eight hands, and at final follow-up, this was sustained in seven hands. Preoperatively, digital ulcerations were present in six hands. After digital debridement and/or amputation, all wounds healed, but in one patient with bilateral disease who continued to smoke, ulcerations recurred without the need for subsequent surgery. Five of six patients were no longer dependent on narcotic analgesics, but use of vasodilator medication did not change. Five of six patients claimed significant improvement in the quality of life after surgery and reported that they would undergo the surgery again. PS in combination with radial and ulnar arteriolysis appears to be efficacious at both early and long-term review. When major inflow occlusion exists and digital blood flow is compromised, vascular reconstruction is recommended if possible. We review our treatment protocol in this complex population of patients.

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“…Comments: Concerning surgical treatments for SSc skin ulcers (except finger/toe amputation), there are two systematic reviews evaluating debridement, skin grafting, sympathectomy, negative pressure wound therapy and surgical relief of joint contracture, and the evidence level is I. However, the recommendation level was reduced to C1, because clear usefulness of surgical treatment has not been demonstrated. There is a case series study concerning debridement and split‐thickness skin grafting for SSc skin ulcers . Shortening of the fingers occurred after debridement, and pain persisted at the wound in some patients after skin grafting. Regarding sympathectomy as a treatment for SSc skin ulcers, there is a systematic review and a case series study .…”

Section: Cq8: Can Intractable Skin Ulcers In Ssc Be Treated Surgically?mentioning

confidence: 99%

The wound/burn guidelines – 4: Guidelines for the management of skin ulcers associated with connective tissue disease/vasculitis

Fujimoto

Asano

Ishii

et al. 2016

The Journal of Dermatology

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The Japanese Dermatological Association prepared guidelines focused on the treatment of skin ulcers associated with connective tissue disease/vasculitis practical in clinical settings of dermatological care. Skin ulcers associated with connective tissue diseases or vasculitis occur on the background of a wide variety of diseases including, typically, systemic sclerosis but also systemic lupus erythematosus (SLE), dermatomyositis, rheumatoid arthritis (RA), various vasculitides and antiphospholipid antibody syndrome (APS). Therefore, in preparing the present guidelines, we considered diagnostic/therapeutic approaches appropriate for each of these disorders to be necessary and developed algorithms and clinical questions for systemic sclerosis, SLE, dermatomyositis, RA, vasculitis and APS.Key words: antiphospholipid antibody syndrome, dermatomyositis, rheumatoid arthritis, systemic lupus erythematosus, vasculitis.Correspondence: Hironobu Ihn, M.D., Ph.D., Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan. Email: ihn-der@kumamoto-u.ac.jp This is the secondary English version of the original Japanese manuscript for The wound/burn guidelines -4: Guidelines for the management of skin ulcers associated with connective tissue disease/vasculitis published in

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Management of sclerodermal finger ulcers

Cited by 30 publications

References 28 publications

Thoracic sympathectomy for digital ischemia: A summary of evidence

Thoracic sympathectomy for digital ischemia: A summary of evidence

Surgery for ischemic pain and Raynaud's' phenomenon in scleroderma: A description of treatment protocol and evaluation of results

The wound/burn guidelines – 4: Guidelines for the management of skin ulcers associated with connective tissue disease/vasculitis

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