58 Articular Surgery for the Scleroderma Hand: Arthrodesis and Arthroplasty

Classic features of systemic scleroderma are disabling and dis-figuring proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joint contractures of the hands. Although surgical correction has often been recommended, seldom has it been employed due to concerns for devitalized wound and compro-mised healing capacity inherent in the disease process. None-theless, despite characteristically ischemic and precarious wound conditions, carefully planned and executed arthrodesis and arthroplasty can prove considerably beneficial to medically stable patients with systemic scleroderma. In the authors ’ experience, techniques of PIP arthrodesis based on dorsal cutaneous arterial (DCA) network and MCP silicone arthroplasty perfused by the dorsal metacarpal collateral artery (DMCA) plexus have consistently demonstrated uncomplicated wound healing and considerably improved function.