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Surgical Approaches Including Sympathectomy

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Atlas of Ulcers in Systemic Sclerosis

Abstract

Although most patients with systemic sclerosis (SSc)-related digital ulcers respond to medical management, a small but significant proportion benefit from surgical treatment. In our opinion the key aspect to successful surgical management is close communication between rheumatologist and surgeon with easy and rapid access to surgery. Fast access to surgical debridement will, in our opinion, often prevent the need for a more extensive surgical debridement or other surgical intervention.

The main indications for surgery are pain, non-healing, and the presence of underlying calcinosis. In this chapter we discuss the available surgical procedures. Surgical debridement and excision of calcinotic deposits are the two most commonly performed procedures. The use of periarterial sympathectomy is increasing. Amputation is required when all other measures fail, although it should be recognized that for many patients this is the best option for providing rapid pain relief, improved function, and also cosmetic relief from black fingers. Other surgical procedures to be considered (although less commonly performed) are balloon angioplasty, arterial reconstruction, and arthrodesis. The roles of botulinum toxin and of fat grafting are still to be evaluated fully.

Patients with SSc often have significant cardiorespiratory problems and thus an increased anesthetic risk; therefore, preoperative anesthetic consultation is advisable. Surgery may often be readily performed under regional anesthesia, for example, metacarpal block anesthesia.

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Author information

Authors and Affiliations

  1. Manchester Hand Centre, Salford Royal NHS Foundation Trust, Salford, Lancashire, UK

    Lindsay Muir

  2. NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

    Ariane L. Herrick

Authors
  1. Lindsay Muir
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  2. Ariane L. Herrick
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Correspondence to Lindsay Muir .

Editor information

Editors and Affiliations

  1. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Marco Matucci-Cerinic

  2. Division of Medicine, University College London, Centre for Rheumatology, Royal Free Hospital, London, UK

    Christopher P. Denton

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Muir, L., Herrick, A.L. (2019). Surgical Approaches Including Sympathectomy. 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_21

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  • DOI: https://doi.org/10.1007/978-3-319-98477-3_21

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  • Print ISBN: 978-3-319-98475-9

  • Online ISBN: 978-3-319-98477-3

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