Abstract
Forty-two patients were evaluated and treated during the past five years at the Union Memorial Hospital Hand Center with the diagnosis of chronic digital ischemia. These patients with this syndrome, manifested by pain, severe cold intolerance and occasional tip ulceration, all were failures of conventional conservative treatment of vasodilators, tobacco abstinence and beta blocking agents. The evaluation consisted of first ruling out large vessel disease by noninvasive techniques of angiography. The patients underwent a variety of noninvasive diagnostic tests including Doppler examination, pulse volume recordings with cold stress, radioisotope scanning of the digital circulation and peripheral sympathetic block of the digital nerves. Treatment included direct microvascular reconstruction of the distal ulnar or radial artery and palmar arch, in ten patients, thermal biofeedback, in 22 patients and a new surgical procedure-digital sympathectomy, in ten patients, involving 18 digits. Eight of ten patients with palmar arch reconstruction improved with seven of ten having patent vein grafts. Thermal biofeedback has been helpful in 20 patients. Testing shows that an increase in digital perfusion can be initiated by all patients. However, only 70% can achieve this improvement. Digital sympathectomy consists of isolating the terminal branches of the sympathetic nerves which travel with the peripheral nerves, dividing these branches and stripping the adventitia of the digital arteries. Eight of nine patients have the experienced improvement in digital circulation, as manifested by pulse volume recordings after operation and radioisotope studies. Pain is substantially alleviated and the ulcers healed. All of these patients responded before operation to the digital nerve block with measured increased in digital perfusion.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Flatt A. E. Digital artery sympathectomy. J Hand Surg Am. 1980 Nov;5(6):550–556. doi: 10.1016/s0363-5023(80)80104-3. [DOI] [PubMed] [Google Scholar]
- Jacobson A. M., Hackett T. P., Surman O. S., Silverberg E. L. Raynaud phenomenon. Treatment with hypnotic and operant technique. JAMA. 1973 Aug 13;225(7):739–740. doi: 10.1001/jama.225.7.739. [DOI] [PubMed] [Google Scholar]
- Mozersky D. J., Buckley C. J., Hagood C. O., Jr, Capps W. F., Jr, Dannemiller F. J., Jr Ultrasonic evaluation of the palmar circulation. A useful adjunct to radial artery cannulation. Am J Surg. 1973 Dec;126(6):810–812. doi: 10.1016/s0002-9610(73)80077-7. [DOI] [PubMed] [Google Scholar]
- Wilgis E. F., Jezic D., Stonesifer G. L., Jr, Classen J. N., Sekercan K. The evaluation of small-vessel flow; a study of dynamic non-invasive techniques. J Bone Joint Surg Am. 1974 Sep;56(6):1199–1206. [PubMed] [Google Scholar]