Managing Complicated Digital Ulcers

Abstract

Two case studies of the management of complicated scleroderma digital ulcers are described in this chapter. These cases have been chosen to represent the two most common types of digital ulcers seen in scleroderma with the most common complications. These cases will be used to discuss the specific management of the problems associated with each case with expanded discussion of the options available, and the reasons for their use. Management of scleroderma digital ulcers in such a way as to achieve progressive healing and reduce the risk to the digit, including amputation, can be very important in the management of scleroderma patients generally. Two cases of complicated digital ulcers are presented representing the most common ulcer types of both systemic sclerosis and limited scleroderma to provide a discussion of scleroderma ulcer management, generally, along with the rationale for the approach to both uncomplicated and complicated scleroderma digital ulcers. Scleroderma ulcers are examples of ischemic ulcers. Patients with systemic sclerosis tend to develop ulcers of the dorsal aspects of their finger interphalangeal joints more commonly than fingertip ulcers that are more common in patients with limited scleroderma. Although the management of the actual wounds is similar, they are distinguished by their initial provocative events: Raynaud’s phenomenon with critical distal digital ischemia more common in limited scleroderma and trauma in the presence of ischemic skin over interphalangeal joint contractures in systemic sclerosis. This chapter will review the options, rationale, and typical progression of management of complicated scleroderma digital ulcers.