Abstract
Cutaneous fistulas, commonly found in association with skin lesions and gangrene, are a severe complication of SSc patients characterized by long-lasting vascular involvement. Local treatment of fistulas is challenging for nurses due to their clinical presentation and the early involvement of deep structures (bones, muscles, and tendons). Fistulas are often associated with infective complications and an increased risk of amputation.
Two cases of SSc patients with cutaneous fistulas have been successfully treated with the association of negative topical pressure (NTP) and split-thickness skin grafting. The placement of a silk thread (seton stitch) for fistulas in skin lesions associated with lymphedema of the legs facilitates the drainage of cavities and promotes healing.
Close monitoring of the ulcer and of its local and systemic symptoms is crucial in order to prevent the evolution of this severe complication. A drainage and a swab should always be obtained when the ulcer is deep, when the deep cutaneous tissue is involved, and when purulent material is abundant across the wound bed. Antiseptic and absorbent dressings are recommended for SSc ulcers complicated with fistulas.
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Piemonte, G., Braschi, F., Rasero, L. (2019). Fistulas. In: Matucci-Cerinic, M., Denton, C. (eds) Atlas of Ulcers in Systemic Sclerosis. Springer, Cham. https://doi.org/10.1007/978-3-319-98477-3_9
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DOI: https://doi.org/10.1007/978-3-319-98477-3_9
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