Purpose
Raynaud's phenomenon is an exaggerated vasospastic response that causes pallor and
cyanosis. In the hand, it results in pain, disability, and the need for amputation.
Current accepted medical and surgical treatments are not uniformly successful and
have their inherent morbidities. Reports in the literature describe the use of botulinum
toxin type A (BTX-A) for the treatment of vasospastic ischemia of the digits. We report
the results of the treatment of recalcitrant digital ischemia with BTX-A in our institution.
Methods
We performed a retrospective chart review between January 2003 and February 2007.
All patients presented with a diagnosis of Raynaud's phenomenon with worsening pain,
discoloration, or nonhealing wound of the hand. Patients received BTX-A injections
into the perineurovascular tissue of the wrist or the distal palm, or along the digit.
Outcomes measured included pain rating, digit color and appearance, transcutaneous
oxygen saturation, and healing of chronic ulcers.
Results
Twenty-six patients were treated, with a total of 55 treatment encounters. Patients
were observed for an average of 18 months. Statistically significant improvements
were noted for pain score and digit transcutaneous oxygen saturation measurements
after treatment (p < .05). We found smokers and women were more likely to have improved
coloration and appearance after injections. Complications included localized injection-related
pain and transient intrinsic muscle weakness.
Conclusions
Botulinum toxin type A significantly improves pain and improves healing in Raynaud's
patients with few complications. BTX-A was found to be a safe and useful treatment
option for vasospastic digital ischemia.
Type of study/level of evidence
Therapeutic IV.
Key words
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References
- Raynaud's phenomenon: a proposal for classification.Clin Exp Rheumatol. 1992; 10 (485–458.)
- Management of Raynaud's phenomenon and digital ischemic lesions in scleroderma.Rheum Dis Clin North Am. 2003; 29: 293-313
- Raynaud's phenomenon in mixed connective tissue disease.Rheum Dis Clin North Am. 2005; 31 (, vi.): 465-481
- Calcium-channel blockers for Raynaud's phenomenon in systemic sclerosis.Arthritis Rheum. 2001; 44: 1841-1847
- Prazosin for Raynaud's phenomenon in progressive systemic sclerosis.Cochrane Database Syst Rev. 1998; (Issue 2. Art. No. CD000956.)
- Digital artery sympathectomy.J Hand Surg. 1980; 5: 550-556
- Digital sympathectomy for vascular insufficiency.Hand Clin. 1985; 1: 361-367
- Surgery for ischemic pain and Raynaud's phenomenon in scleroderma: a description of treatment protocol and evaluation of results.Microsurgery. 2001; 21: 75-79
- Calcium channel blockers for primary Raynaud's phenomenon: a meta-analysis.Rheumatology (Oxford). 2005; 44: 145-150
- Botulinum toxin in the treatment of Raynaud's phenomenon: a pilot study.Eur J Clin Invest. 2004; 34: 312-313
- Management of vasospastic disorders with botulinum toxin A.Plast Reconstr Surg. 2007; 119: 217-226
- Pain: a review of three commonly used pain rating scales.J Clin Nurs. 2005; 14: 798-804
- Primer of Biostatistics. Glantz, McGraw-Hill, New York1996: 85-102 (version 4.02.)
- Differential inhibition by botulinum neurotoxin A of cotransmitters released from autonomic vasodilator neurons.Am J Physiol Heart Circ Physiol. 2001; 281: H2124-H2132
- The effects of botulinum toxin type A on muscle blood perfusion and metabolism.Plast Reconstr Surg. 2007; 120: 1823-1833
- Botulinum toxin type A in chronic migraine.Expert Rev Neurother. 2007; 7: 463-470
- Botulinum toxin type A therapy for cervical dystonia.Cochrane Database Syst Rev. 2005; (Issue 1. Art. No. CD003633.)
- A randomized, double masked, controlled trial of botulinum toxin type A in essential hand tremor.Neurology. 2001; 56: 1523-1528
- Systemic sclerosis: blood rheometry and laser Doppler imaging of digital cutaneous microcirculation during local cold exposure.Clin Hemorheol Microcirc. 1998; 18: 47-58
Article info
Publication history
Accepted:
November 24,
2008
Received:
August 12,
2008
Footnotes
The authors thank Nandita Mani for assistance in the preparation of this article.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2009 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
