Wound Dressing for Digital Ulcers in Systemic Sclerosis

Abstract

The management of ulcers is a real challenge for physicians and nurses. In systemic sclerosis (SSc), the treatment of digital ulcers (DU) should improve tissue integrity and viability, promote ulcer healing, and reduce the formation of new DU. Wound healing is a complex process regulated by a pattern of events including coagulation, inflammation, formation of granulation tissue, epithelialization, and tissue remodeling. The observation of the ulcer characteristics is fundamental to choose the strategy, and a multidisciplinary approach is required, including both systemic and local treatment, using a combination of non-pharmacological care, antibiotics if an infection is suspected, and surgical intervention in most severe cases. Furthermore, educational aspects are of paramount importance.

The structured approach to management of chronic wounds in SSc is represented by wound bed preparation (WBP) that includes different steps as detersion and debridement (passive debridement, active debridement, selective debridement, nonselective debridement, and maintenance debridement). The removal of foreign material and devitalized or contaminated tissue from or adjacent to the lesion is important because it is well known that tissue necrosis and slough may release cytokines that can frequently determine pain and worsen the status of DU. Debridement can be achieved through surgical, enzymatic, autolytic, mechanic, or biological methods. New research on wound care has focused on the “advanced” dressings that can help the operator with difficult/chronic lesions. These products are able to trigger the healing process of a lesion during the different phases, keeping a moist environment in the lesion. There are more than 1000 different dressings to choose in the different stages of the ulcers including transparent film dressings, barrier cream, oil solution fatty acids, hydrogel, non-adherent dressing, hydrocolloid dressing, polyurethane foams, alginate, hydrophilic dressing, collagen and cellulose dressing, hyaluronic acid dressing, modulators of protease metal, hydrophobic dressings for controlling bacterial charge, and dressings with silver. Obviously, infections necrosis and gangrene can complicate the scenario. For this reason, the physician must foster vascularization as much as possible, while the nurse will choose the most appropriate dressings for the wound characteristics. This combined approach may significantly accelerate wound healing and improve the quality of life of SSc patients.