Nonoperative Management of Scleroderma of the Hand With Tadalafil and Subatmospheric Pressure Wound Therapy: Case Report

• Published in: The Journal of hand surgery (American ed.) Vol. 37; no. 4; pp. 803 - 806
• Main Authors: Patel, Ronak M., MD, Nagle, Daniel J., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2012; Elsevier
• Subjects: Adult; Biological and medical sciences; Carbolines - therapeutic use; Combined Modality Therapy; Diseases of the osteoarticular system; Hand - blood supply; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Negative pressure wound therapy; Orthopedics; Phosphodiesterase 5 Inhibitors - therapeutic use; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; scleroderma; Scleroderma, Systemic - drug therapy; Scleroderma, Systemic - therapy; Tadalafil; Traumas. Diseases due to physical agents; Wound Healing; Negative pressure wound therapy; scleroderma; Subatmospheric pressure; Skin disease; Vasodilator agent; 3',5'-Cyclic-GMP phosphodiesterase; Autoimmune disease; Esterases; Phosphoric diester hydrolases; Negative pressure; Wound; Systemic disease; Scleroderma; Human; Immunopathology; Connective tissue disease; Enzyme; Rheumatology; Enzyme inhibitor; Hand; Phosphodiesterase inhibitor; Phosphodiesterase 5 inhibitor; Case study; Tadalafil; Carboline derivatives; Treatment; Orthopedics; Hydrolases
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2011.12.030

Scleroderma, or systemic sclerosis (SS), is an autoimmune disease leading to ischemic fibrosis and widespread collagen deposition, invariably affecting the hands. Optimized medical management remains the mainstay of therapy for SS. Surgery can be considered in refractory or severely disabling cases. However, microvascular insufficiency and fibrosis can lead to wound complications and, ultimately, amputation. We present the case of a 61-year-old man with a known history of scleroderma who presented with pain, chronic infection, and ulcerations in the left hand. Initially, amputation seemed a reasonable intervention. After medical optimization with tadalafil, his ulcerations persisted. Instead of amputation, we applied a subatmospheric pressure wound therapy device to his hand. In 4 months, his wounds had healed, there was no evidence of infection, and no digits were amputated.