POS0921 DIGITAL GANGRENE IN SYSTEMIC SCLEROSIS: AUTOLOGOUS FAT GRAFTING AND BONE SHAVING TO AVOID AMPUTATION

Abstract

Background: Systemic Sclerosis (SSc) is a connective tissue disease characterized by microvascular dysfunction, abnormal fbroblast activation and antibodies production, with cutaneous and visceral involvement. Hand-related manifestations include sclerosis, loss of elasticity, sclerodactyly, painful digital ulcers, atrophy, and gangrene. Autologous fat grafting is based on the implantation of adipose-derived stem cell (ADSCs) which have demonstrated to have pro-angiogenic, anti-infammatory, regenerative, and immunosuppressive properties. This technique, combined with bone shaving, is believed to be effective in avoiding fnger amputation in SSc-patients affected by digital gangrene. Objectives: Evaluate our experience with the use of autologous fat grafting and bone shaving for the treatment of digital necrosis in patients affected by SSc. Methods: According to our schedule, we treated 7 female SSc patients with digital gangrene and exposed bone at the fngertips, enrolled in our University Hospital from March 2018 to January 2020. Digital gangrene was treated by a combination of bone shaving and autologous fat grafting in order to avoid amputation. During the bone shaving, necrotic tissue was removed until bone bleeding was obtained. This procedure could be repeated by trained rheumatologists every 2 weeks in our Clinic. The aim of this repeated debridement was to promote the progression of the granulation tissue inside the dead tissue of the fnger. Autologous fat grafting consists of a surgical procedure of ADSCs implantation at the base of the fnger. It is performed in order to empower the neurovascular bundle and improve tissue healing. This treatment could be performed every 3 months by trained plastic surgeons. The combination of these two techniques allows the maximum fnger length preservation. Results: Complete healing of all fngers was achieved in 6-12 months by performing bone shaving every 2 weeks and 2 treatments of autologous fat grafting. Results have proved to be long-lasting. At 1-year follow-up, patients did not present any recurrence. Every procedure was performed under local anaesthesia and appropriate analgesic therapy. A high degree of compliance and satisfaction of all patients was noted. Conclusion: Finger amputation in Systemic Sclerosis should be avoided. This traumatic surgical procedure is responsible for microvascular damages worsening SSc-related vasculopathy. Stump ulcers often occurs and wound healing usually takes place by secondary intention. In our experience, the combination of bone shaving and autologous fat grafting has proven to be effective and safe in preserving the maximum amount of viable tissue and obtaining a long-lasting result in treated SSc patients.