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Digital Loss (Gangrene, Amputation, Autoamputation)

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Abstract

Digital loss is the most serious and fearful complication of digital ulcers (DUs) in systemic sclerosis (SSc). It may occur as a consequence of gangrene that leads to an autoamputation or to surgical amputation or as a result of amputation performed for other reasons, as severe osteomyelitis.

It has been estimated that 5–10% of all SSc patients develops gangrene or undergo amputation (Steen et al. Rheumatology (Oxford) 48(Suppl 3):S19–S24, 2009; Poormoghim et al. Rheumatol Int 33(8):1943–1950, 2013; Muangchan et al. J Rheumatol 40(9):1545–1556, 2013). The risk of gangrene and amputation increases to 20% in patients with DUs (Denton et al. Ann Rheum Dis. 2012;71(5):718-21; Hachulla et al. J Rheumatol 2007;34:2423–30; Allanore et al. Ann Rheum Dis2015;74(Suppl2): 818), while the incidence of amputation ranges from 1% to 2% of patients/year (Denton et al. Ann Rheum Dis. 2012;71(5):718-21; Hachulla et al. J Rheumatol 2007;34:2423–30).

This chapter will describe causes and features of gangrene which represents the major cause of digital loss in SSc, as well as causes and complications of amputation and autoamputation.

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References

  1. Taylor MH, McFadden JA, Bolster MB, Silver RM. Ulnar artery involvement in systemic sclerosis (scleroderma). J Rheumatol. 2002;29:102–6.

    CAS  PubMed  Google Scholar 

  2. Kaide CG, Khandelwal S. Hyperbaric oxygen: applications in infectious disease. Emerg Med Clin North Am. 2008;26(2):571–95.

    Article  Google Scholar 

  3. Tagil M, Dieterich J, Kopylov P. Wound healing after hand surgery in patients with systemic sclerosis--a retrospective analysis of 41 operations in 19 patients. J Hand Surg Eur. 2007;32(3):316–9.

    Article  CAS  Google Scholar 

  4. Steen V, Denton CP, Pope JE, Matucci-Cerinic M. Digital ulcers: overt vascular disease in systemic sclerosis. Rheumatology (Oxford). 2009;48(Suppl 3):S19–24.

    Google Scholar 

  5. Poormoghim H, Moghadam AS, Moradi-Lakeh M, Jafarzadeh M, Asadifar B, Ghelman M, Andalib E. Systemic sclerosis: demographic, clinical and serological features in 100 Iranian patients. Rheumatol Int. 2013;33(8):1943–50.

    Article  CAS  Google Scholar 

  6. Muangchan C, Canadian Scleroderma Research Group, Baron M, Pope J. The 15% rule in scleroderma: the frequency of severe organ complications in systemic sclerosis: a systematic review. J Rheumatol. 2013;40(9):1545–56.

    Article  Google Scholar 

  7. Denton CP, Krieg T, Guillevin L, Schwierin B, Rosenberg D, Silkey M, Zultak M, Matucci-Cerinic M, DUO Registry investigators. Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis: data from the DUO registry. Ann Rheum Dis. 2012;71(5):718–21.

    Article  Google Scholar 

  8. Hachulla E, Clerson P, Launay D, et al. Natural history of ischemic digital ulcers in systemic sclerosis: single-center retrospective longitudinal study. J Rheumatol. 2007;34:2423–30.

    PubMed  Google Scholar 

  9. Allanore Y, Denton CP, Krieg T, Cornelisse P, Rosenberg D, Schwierin B, Matucci-Cerinic M. Clinical characteristics of systemic sclerosis patients with digital ulcer disease who developed gangrene: data from DUO registry. Ann Rheum Dis. 2015;74(Suppl2):818.

    Google Scholar 

  10. Nihtyanova SI, Brough GM, Black CM, Denton CP. Clinical burden of digital vasculopathy in limited and diffuse cutaneous systemic sclerosis. Ann Rheum Dis. 2008;67:120–3.

    Article  CAS  Google Scholar 

  11. Amanzi L, Braschi F, Fiori G, Galluccio F, Miniati I, Guiducci S, Conforti ML, Kaloudi O, Nacci F, Sacu O, Candelieri A, Pignone A, Rasero L, Conforti D, Matucci-Cerinic M. Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation of 1614 digital lesions. Rheumatology (Oxford). 2010;49:1374–82.

    Article  Google Scholar 

  12. Harrison BJ, Silman AJ, Hider SJ, Herrick AL. Cigarette smoking as a significant risk factor for digital vascular disease in patients with systemic sclerosis. Arthritis Rheum. 2002;46(12):3312–6.

    Article  Google Scholar 

  13. Caramaschi P, Biasi D, Caimmi C, Barausse G, Sabbagh D, Tinazzi I, LA Verde V, Tonetta S, Adami S. Digital amputation in systemic sclerosis: prevalence and clinical associations: a retrospective longitudinal study. J Rheumatol. 2012;39(8):1648–53.

    Article  Google Scholar 

  14. Wigley FM, Wise RA, Miller R, Needleman BW, Spence RJ. Anticentromere antibodies as a predictor of digit ischemic loss in patients with systemic sclerosis. Arthritis Rheum. 1992;35:688–93.

    Article  CAS  Google Scholar 

  15. Boin F, Franchini S, Colantuoni E, Rosen A, Wigley FM, Casciola-Rosen L. Independent association of anti-β2-glycoprotein I antibodies with macrovascular disease and mortality in scleroderma patients. Arthritis Rheum. 2009;60(8):2480–9.

    Article  Google Scholar 

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Blagojevic, J. (2019). Digital Loss (Gangrene, Amputation, Autoamputation). In: Matucci-Cerinic, M., Denton, C. (eds) Atlas of Ulcers in Systemic Sclerosis. Springer, Cham. https://doi.org/10.1007/978-3-319-98477-3_11

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  • DOI: https://doi.org/10.1007/978-3-319-98477-3_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98475-9

  • Online ISBN: 978-3-319-98477-3

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