Backby Charles P. Melone, Jr., M.D.
Professor of Orthopedics and Director of the Hand Surgery Program,
NYU Medical School, New York, New York
Progressive deformity of the hands constitutes one of the more prevalent, disabling, and distressing visible manifestations of scleroderma. Small joint contractures, recurrent ulceration, infection, and calcinosis render the hands increasingly dysfunctional and, for those afflicted, are a source of both continual pain and serious disfigurement
In an effort to lessen profound morbidity associated with scleroderma of the hands, reconstructive hand surgery has been employed with increasing frequency over the past decade. For carefully selected patients whose general medical condition is considered optimal, specific surgical techniques have become truly rewarding methods of affording substantial improvement for the scleroderma hand. The technique of corrective arthrodesis (definition: surgical fusion of a destroyed joint in a more functional and aesthetic position) has been especially beneficial for severely contracted small knuckles, termed the proximal interphalangeal joints; whereas arthroplasty (definition: joint replacement) has been successfully applied to stiffened larger knuckles, termed the metacarpophalangeal joints. Uncomplicated surgical excision of painful calcium deposits can be performed, contingent on size and location, as either a one or multiple stage procedure.
Personal experience with more than 200 surgical cases has proved these techniques to be highly reliable in correcting deformities, alleviating pain, and considerably improving appearance. Moreover this experience has demonstrated that persons with scleroderma, despite a characteristically poor blood circulation, have the capacity to heal both skin wounds and reconstructed bones and have consistently benefited from well-conceived, timely reconstructive hand surgery. In the vast majority of cases, functional and cosmetic improvement has been the rule.
This article appeared in the Third Quarter 1995 issue of The Scleroderma Spectrum, a publication of the United Scleroderma Foundation.