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Surgical management of digital ulcers in systemic sclerosis: A systematic literature review.
Suliman, Yossra A; Campochiaro, Corrado; Hughes, Michael; Schoones, Jan W; Giuggioli, Dilia; Moinzadeh, Pia; Baron, Murray; Chung, Lorinda; Ross, Laura; Maltez, Nancy; Allanore, Yannick; Denton, Christopher P; Distler, Oliver; Frech, Tracy; Furst, Daniel E; Khanna, Dinesh; Krieg, Thomas; Kuwana, Masataka; Matucci-Cerinic, Marco; Pope, Janet; Alunno, Alessia.
Afiliación
  • Suliman YA; Rheumatology and Rehabilitation Dept, Assiut University Hospital, Assiut, Egypt. Electronic address: ysuliman@aun.edu.eg.
  • Campochiaro C; IRCCS San Raffaele Hospital, Vita-Salute San Raffaele Università, Milan, Italy.
  • Hughes M; Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Northern Care Alliance NHS Foundation Trust, Salford Care alliance, Manchester Academic Health Science Centre, Manchester, UK.
  • Schoones JW; Directorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, the Netherlands.
  • Giuggioli D; University of Modena, Italy.
  • Moinzadeh P; Department of Dermatology and Venereology, University Hospital of Cologne, Germany.
  • Baron M; Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
  • Chung L; Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, CA, USA.
  • Ross L; The University of Melbourne, Melbourne, VIC, Australia; St Vincent's Hospital, Melbourne, Australia.
  • Maltez N; University of Ottawa, Ottawa, ON, Canada.
  • Allanore Y; Paris Descartes University, Paris, France.
  • Denton CP; University College London, London, United Kingdom.
  • Distler O; University of Zurich, Zurich, Switzerland.
  • Frech T; University of Utah, Veterans Affairs Medical Center, Salt Lake City, UT, USA.
  • Furst DE; University of California, Los Angeles, Los Angeles, CA, USA.
  • Khanna D; University of Michigan, Ann Arbor, MI, USA.
  • Krieg T; Department of Dermatology and Venereology, University Hospital of Cologne, Cologne, Germany.
  • Kuwana M; Nippon Medical School, Tokyo, Japan.
  • Matucci-Cerinic M; University of Florence, Florence, Italy.
  • Pope J; Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
  • Alunno A; Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit and Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
Semin Arthritis Rheum ; 63: 152266, 2023 12.
Article en En | MEDLINE | ID: mdl-37826898
BACKGROUND: There is a strong rationale to develop locally-acting surgical treatments for digital ulcers (DUs) in patients with systemic sclerosis (SSc). Our aim was to examine the safety and efficacy of local surgical management for SSc-DU. METHODS: A systematic literature review was carried out until to August 2022 using 7 different databases. Original research studies concerning adult patients with SSc-DUs, and local surgical treatments were analysed using the PICO framework. We included randomized controlled trials, prospective/retrospective studies, and case series (minimum of 3 patients) References were independently screened by two reviewers including assessment of the risk of bias using validated tools. RESULTS: Out of 899, 13eligible articles were included. Autologous fat (adipose tissue AT) grafting was the surgical modality most identified (7 studies, 1 randomized controlled double blinded trial and 6 prospective open-label single arm studies). The healing rate (HR) with autologous fat grafting (4 studies) was 66-100 %. Three studies reported autologous adipose-derived stromal vascular fraction grafting: HR of 32-60 %. Bone marrow derived cell transplantation in a single study showed 100 % healing rate over 4-24 weeks. Surgical sympathectomy was examined in 3 studies, prospective without comparator with a median healing rate of 81 %. Two surgical studies (of direct microsurgical revascularisation and microsurgical arteriolysis) showed 100 % healing of ulcers, with no complications. CONCLUSION: Several surgical approaches for SSc-DUs have demonstrated some degree of safety and effectiveness for DU healing. However, there are significant methodological issues. Future studies are warranted to rigorously investigate surgical interventions for SSc-DUs.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Esclerodermia Sistémica / Úlcera Cutánea Tipo de estudio: Systematic_reviews Límite: Adult / Humans Idioma: En Revista: Semin Arthritis Rheum Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Esclerodermia Sistémica / Úlcera Cutánea Tipo de estudio: Systematic_reviews Límite: Adult / Humans Idioma: En Revista: Semin Arthritis Rheum Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos