Successful treatment of an extended leg ulcer in systemic sclerosis.
We report the successful surgical treatment of a large and painful leg ulcer associated with systemic sclerosis (scleroderma). In addition, there was a long occlusion of the superficial femoral artery, and ankle systolic blood pressure was 80 mmHg (ankle-brachial-index 0.65). All conservative treatments including systemic antibiotics, nifedipine, intravenous iloprost, intravenous penicilline G and hyperbaric oxygen failed. Pain was intolerable and below-knee amputation was considered. In a first attempt to save the limb, the patient underwent femoropopliteal bypass surgery. Despite a successful outcome of the bypass operation and normalization of the ankle blood pressure, the large wound remained recalcitrant and extremely painful. A second attempt to save the limb consisted of complete debridement of all sclerotic tissue down to the fascia and split skin grafting. The graft took in over 90% of the surface and the remaining wound healed spontaneously. Large leg ulcers in systemic sclerosis can become limb threatening. Radical debridement combined with a split skin graft seems to be a promising way to avoid amputation.
Hafner
J
J
Department of Dermatology, University Hospital of Zurich.
Kohler
A
A
Enzler
M
M
Brunner
U
U
D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D007871:Leg Ulcer / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012595:Scleroderma, Systemic / Q000601:surgery*; D016038:Skin Transplantation