Scleroderma is a chronic disease that involves the tightening and hardening of the skin and connective tissue. This medical illustration presents the surgical management of the hand in scleroderma: interphalangeal arthrodesis. The proper digital artery (PDA) and dorsal cutaneous branches (DCB) are highlighted in the fingers. The characteristics and indication for surgery are skin ulceration, severe flexion contracture of the interphalangeal joints and sclerodactyly.Dorsal transverse incisions over the contracted joints preserve circulation. Surgical fixation with fine Kirschner wires in a crossed pattern is applied. After surgery the hand is allowed to heal and the wires are removed.