Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, Turin, Italy.
Aesthetic Plast Surg. 2013 Dec;37(6):1214-9. doi: 10.1007/s00266-013-0224-z. Epub 2013 Oct 19.
As a limited form of sclerodermy, CREST syndrome is characterized by calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia, which determine the acronym CREST. Calcinosis is a particularly difficult entity to treat given the paucity of effective options described in the literature. Treatment of finger calcinosis has a wide range of possibilities depending on the extent of calcifications and the involvement of deep structures. From a surgical point of view, whereas simple removal is adequate in minor outpatient cases, a radical debridement in the major and more painful cases seems required. A cover flap is needed particularly in the thumb due to its great functional importance, also if the fingertip is not involved. The authors recommend the kite flap for the dimensions, the tissue quality, and the possibility of giving sensation to the reconstructed area. With this surgical option, the transferred skin is soft, sensate, and the right fit. Usually, no further operations are needed for flap remodeling. The time required for sensory integration is about 2 years, often related to the age of the patient. Debridement and flap reconstruction usually give total resolution of pain, with complete recovery of thumb motion and the thumb-index finger grip.
作为硬皮病的一种有限形式，CREST 综合征的特征是钙质沉着症、雷诺现象、食管动力障碍、硬皮病和毛细血管扩张，这决定了 CREST 的缩写。由于文献中描述的有效选择很少，钙质沉着症是一种特别难以治疗的实体。根据钙化的程度和深部结构的受累情况，手指钙质沉着症的治疗有广泛的可能性。从手术的角度来看，对于较小的门诊病例，简单切除即可，但对于较大和更疼痛的病例，似乎需要彻底清创。由于拇指的功能非常重要，即使指尖未受累，也需要覆盖皮瓣。由于其尺寸、组织质量以及为重建区域提供感觉的可能性，作者推荐风筝皮瓣。通过这种手术选择，转移的皮肤柔软、敏感，并且合适。通常，皮瓣重塑不需要进一步的手术。感觉整合所需的时间约为 2 年，通常与患者的年龄有关。清创和皮瓣重建通常可以完全缓解疼痛，拇指运动和拇指-食指握力完全恢复。
