Sound Evidence - April 2008 - (Page 65) or beraprost sodium, intravenous iloprost, and treprostinil subcutaneous infusion) or aid healing of (intravenous iloprost and treprostinil subcutaneous infusion) SSc-associated digital ulcers. Case series studies of 10 and 20 patients, respectively, have suggested potential roles for sildenafil12 and N-acetylcysteine13 in healing digital ulcers. Surgical procedures for nonhealing digital ulcers include microsurgical revascularization, digital arterial reconstruction, and digital sympathectomy.4 Conclusion Acoustic pressure wound therapy is generally utilized in the care of pressure, venous, arterial, surgical, trauma, and neuropathic ulcers. However, its indication — to promote wound healing through cleansing and maintenance debridement by removing fibrin, yellow slough, tissue exudates, and bacteria — is not wound-type specific. Based on the complete healing of this infected digital ulcer at risk for fingertip amputation and the lack of treatmentassociated pain, APWT also may provide clinical benefit in the treatment of painful digital ulcers in the complex milieu of systemic sclerosis. - OWM Acknowledgment The author thanks Laurie LaRusso, MS, ELS, for her primary contribution to the writing of this manuscript. References 1. Ferri C, Valentini G, Cozzi F, et al. Systemic sclerosis: demographic, clinical, and serologic features and survival in 1,012 Italian patients. Medicine (Baltimore). 2002;81(2):139–153. 2. Korn JH, Mayes M, Matucci Cerinic M, et al. Digital ulcers in systemic sclerosis: prevention by treatment with bosentan, an oral endothelin receptor antagonist. Arthritis Rheum. 2004;50(12):3985–3993. 3. Mawdsley AH. Patient perception of UK scleroderma services — results of an anonymous questionnaire. Rheumatology (Oxford). 2006;45(12):1573. 4. Chung L. Therapeutic options for digital ulcers in patients with systemic sclerosis. J Dtsch Dermatol Ges. 2007;5(6):460–465. 5. Nihtyanova SI, Brough GM, Black CM, Denton CP. Clinical burden of digital vasculopathy in limited and diffuse cutaneous systemic sclerosis. Ann Rheum Dis. 2008;67(1):120–123. 6. Milburn PB, Singer JZ, Milburn MA. Treatment of scleroderma skin ulcers with a hydrocolloid membrane. J Am Acad Dermatol. 1989;21(2 Pt 1):200–204. 7. Gehling ML, Samies JH. The effect of noncontact, low-intensity, low-frequency therapeutic ultrasound on lower-extremity chronic wound pain: a retrospective chart review. Ostomy Wound Manage. 2007;53(3):44–50. 8. Unger P. Low- frequency, noncontact, nonthermal ultrasound therapy: a review of the literature. Ostomy Wound Manage. 2008;54(1):57–60. 9. Kavros SJ, Schenck EC. Use of noncontact low-frequency ultrasound in the treatment of chronic foot and leg ulcerations: a 51-patient analysis. J Am Podiatr Med Assoc. 2007;97(2):95–101. 10. Filho JP, Sampaio-Barros PD, Parente JB, et al. Rhythmic external compression of the limbs: a method for healing cutaneous ulcers in systemic sclerosis. J Rheumatol. 1998;25(8):1540–1543. 11. Markus YM, Bell MJ, Evans AW. Ischemic scleroderma wounds successfully treated with hyperbaric oxygen therapy. J Rheumatol. 2006;33(8):1694–1696. 12. Gore J, Silver R. Oral sildenafil for the treatment of Raynaud's phenomenon and digital ulcers secondary to systemic sclerosis. Ann Rheum Dis. 2005;64(9):1387. 13. Sambo P, Amico D, Giacomelli R, et al. Intravenous N-acetylcysteine for treatment of Raynaud's phenomenon secondary to systemic sclerosis: a pilot study. J Rheumatol. 2001;28(10):2257–2262. April 2008 Vol. 54 Issue 4 65
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