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, in travenous iloprost, intravenous penicilline G and hyperbaric oxygen fa iled. Pain was intolerable and below-knee amputation was consered 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 remaine d recalcitrant and extremely painful. A second attempt to save the lim b consisted of complete debridement of all sclerotic tissue down to th e fascia and split skin grafting. The graft took in over 90% of the su rface and the remaining wound healed spontaneously. Large leg ulcers i n systemic sclerosis can become limb threatening. Radical debridement combined with a split skin graft seems to be a promising way to avoid amputation.