Surgical management of digital calcinosis in CREST syndrome

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.

Publication types

  • Review

MeSH terms

  • CREST Syndrome / diagnosis
  • CREST Syndrome / surgery*
  • Calcinosis / diagnosis
  • Calcinosis / surgery*
  • Debridement / methods
  • Female
  • Graft Survival
  • Humans
  • Male
  • Plastic Surgery Procedures / methods*
  • Recovery of Function
  • Risk Assessment
  • Severity of Illness Index
  • Surgical Flaps / blood supply
  • Surgical Flaps / transplantation*
  • Thumb / physiopathology
  • Thumb / surgery*
  • Treatment Outcome
  • Wound Healing / physiology