🖐️ Digital Ulcer and Critical Ischemia Risk Simulator

Recurrent Severe Vasospasm Episodes

Secondary Raynaud's drives repeated, severe digital artery spasm.

• Scleroderma: Common Cause (systemic sclerosis)
• Cold / Stress: Episode Trigger (placeholder)
• Digital Artery: Vessel Affected (placeholder)
• Secondary: Severity Class (vs primary Raynaud's)

Vasospasm mechanism

Cold or stress triggers exaggerated digital artery constriction.

Secondary Raynaud's carries higher ulcer risk than primary.

Underlying disease link

Scleroderma-associated vasculopathy amplifies spasm frequency and severity.

Early warning signs

Color change progresses white, blue, then red on rewarming.

Microvascular Occlusion Begins

Repeated ischemic episodes damage fingertip tissue over time.

• Capillary Bed: Vessel Level (placeholder)
• Endothelial Injury: Damage Type (placeholder)
• Progressive: Flow Reduction (placeholder)
• Diminishing: Reversibility (placeholder)

Repeated ischemia damage

Each spasm cycle chips away at fingertip microcirculation.

Chronic hypoxia sets the stage for tissue breakdown.

Occlusion onset

Small vessels begin to plug, blood flow drops further.

Subclinical injury

Damage often precedes any visible skin change.

Digital Ulcer Formation

Skin breakdown occurs at the fingertip pad under stress.

• Fingertip Pad: Ulcer Site (placeholder)
• Impaired: Healing Rate (poor blood supply)
• Often Severe: Pain Level (placeholder)
• Elevated: Infection Risk (placeholder)

Skin breakdown

Ischemic tissue ulcerates where perfusion is weakest.

Poor blood supply stalls normal wound healing.

Chronic wound behavior

Ulcers linger for weeks without adequate perfusion.

Clinical monitoring

Size and depth tracked to guide therapy decisions.

Risk Factors Worsen Ischemia

Smoking, disease severity, and undertreatment compound ischemic risk.

• Smoking: Risk Factor 1 (vasoconstrictive)
• Disease Severity: Risk Factor 2 (placeholder)
• Undertreated: Risk Factor 3 (inadequate therapy)
• Multiplicative: Combined Effect (placeholder)

Smoking impact

Nicotine sustains vasoconstriction, worsening tissue hypoxia.

Each added risk factor compounds ischemic burden.

Disease severity

Advanced scleroderma correlates with more frequent ulcers.

Undertreatment

Inadequate vasodilator dosing leaves ischemia unchecked.

Healing vs Critical Ischemia

Risk control and vasodilator therapy determine the outcome.

• Ulcer Heals: Good Path (placeholder)
• Critical Ischemia: Poor Path (placeholder)
• Gangrene Risk: Worst Case (placeholder)
• Weeks of Care: Key Lever (placeholder)

Favorable trajectory

Risk control plus therapy allows re-epithelialization over weeks.

Early, sustained management favors healing over necrosis.

Unfavorable trajectory

Persistent risk factors drive tissue toward necrosis.

Clinical takeaway

Vasodilator therapy and risk reduction are time-sensitive.