Abstract
The optimal management of SSc cutaneous ulcers should be focused on both pharmacological systemic modalities and local treatment. A preliminary and thorough clinical assessment is always recommended to carry out a rational and efficacious approach to the local treatment of SSc ulcers. It is mandatory to evaluate SSc ulcers’ related pain, their pathogenesis, their localization and their dimensions. The local therapy is based on the principles of wound bed preparation (WBP), a practical framework providing a structured assessment and treatment of chronic ulcers. The acronym TIME summarizes the four main components of WBP: T tissue management, I control of Infection/inflammation, M moisture imbalance for a proper range of hydration and E advancing epithelial edges of the wound. In SSc cutaneous ulcers, tissue management is ensured by an association with sharp debridement and autolytic medications that hydrate necrotic tissue and facilitate its removal. Infection must be recognized promptly and treated with an efficacious debridement and topic antimicrobial dressings. The proper range of moisture is mandatory to protect viable tissue and promote granulation tissue. The management of the epithelial edges of wound has the aim to promote epithelialisation consisting in active division, maturation and migration of keratinocytes from the edges of the ulcer across the wound bed. The synergistic action of systemic and local treatment allows skin perfusion and its trophism.
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Piemonte, G., Benelli, L., Braschi, F., Rasero, L. (2019). The Local Treatment: Methodology, Debridement and Wound Bed Preparation. 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_18
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