title: Successful treatment of an extended leg ulcer in systemic sclerosis.
abstract: 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.
authors.affiliation: Department of Dermatology, University Hospital of Zurich.
authors.forename: J
authors.initials: J
authors.lastname: Hafner
authors.forename: A
authors.initials: A
authors.lastname: Kohler
authors.forename: M
authors.initials: M
authors.lastname: Enzler
authors.forename: U
authors.initials: U
authors.lastname: Brunner
mesh_terms: 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