Abstract
Introduction: Systemic sclerosis of the hand is an uncommon form of arthritis that can cause significant functional loss in the hand. Because of decreased microcirculation, wound-healing problems are feared and surgical interventions avoided. We report the results after operations performed on the hand and forearm of patients with systemic sclerosis with special reference to wound healing problems.
Material and methods: This retrospective study evaluates the results of 41 consecutive operations performed in 19 patients between 1985 and 2000 at our unit. The mean age was 50 years (14 – 84 years). Sixteen patients were female and 3 male. Twelve patients were operated twice or more. Operations were elective in 27 cases, with excision of calcinosis in 8 patients, excision of calcinosis plus skin transplant in 2 patients, neurolysis of median, radial or ulnar nerve in 7 patients, wrist procedures (fusion or implant) in 3 patients and other procedures (e. g. finger joint fusion, removal of osteosynthetis material, finger osteotomy) in 7 patients.
In 14 cases the operations were indicated in reason of spontaneous skin necrosis or defects. These operations were: amputation with or without flap in 3 cases, wound revision in 6 cases, wound revision and flap in 5 cases (including skin transplantation in 3 of these patients).
Results: One wound healing problem occurred in the 27 elective operations. The patient operated with an arthrodesis of the small finger PIP-joint had to have both the cerclage wire and K-wire removed to obtain complete wound healing.
Seven of 14 patients in the group with spontaneous skin necrosis healed uneventfully after operation. Two patients had consecutive wound infections that caused a longer healing period of 5 months; another patient also had a longer healing period but his wounds healed shortly after he quit smoking. Four patients had necrosis/infections, which required additional surgery.
Conclusion: In systemic sclerosis, surgery performed in elective operations does not seem to have an increased rate of infections or other wound healing problems. Even larger operations like wrist arthrodesis or wrist prosthesis can be performed. In non-elective cases with spontaneous skin necrosis, in critically ischaemic fingers, the wound healing is not always easy and several operations can be necessary, however a good end result, without need for amputations, can be achieved.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
