Novel Combined Approach for Digital Necrosis Secondary to Raynaud’s Phenomenon

Vegas, Diego Herrera; Fabiani, Mario Alejandro; Bignotti, Agustín; Seré, Ignacio; Salvadores, Pablo

doi:10.1177/15385744211005663

Cited by 2 publications

(11 citation statements)

References 26 publications

(33 reference statements)

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“…9,15,25,26,43,44 There were 7 case series', including a range of 2 to 11 patients. 4,20,28,31,[35][36][37] There were 15 single case reports, 1,2,5,10,14,17,21,23,24,27,29,32,33,40,46 1 piece of original research, 38 and 1 clinical trial. 45 The largest study was a randomized trial by Motegi et al 26 in 2017, which included 45 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Nine of 42 studies used either ultrasound, Doppler ultrasound, CT angiography, or magnetic resonance angiography to measure blood flow after BT injection. 5,9,[12][13][14]19,25,31,38 Five of these 9 reported improved blood flow after BT injection. Two of the 9 had very mixed results, including both increased and decreased perfusion in their participants.…”

Section: Positive Resultsmentioning

confidence: 99%

“…Figure 2 represents the locations of some of the most commonly used injection techniques from the studies. The most frequently used technique was seen in 42.9% (18 of 42) 2,5,[12][13][14][15]18,19,[21][22][23]26,31,34,36,42,43,45 of the studies in Table 1. These used a method similar to that described by Neumeister in 2009.…”

Section: Injection Techniquesmentioning

confidence: 99%

“…However, 5 studies in Table 1 used a dorsal approach. 5,25,34,41,44 One hundred twelve patients were treated in these 5 studies, and only 5 patients (4.5%) experienced transient weakness after injection. Because not all studies reported this data, it is difficult to calculate the proportion of patients experiencing weakness after a palmar approach.…”

Section: Injection Techniquesmentioning

confidence: 99%

“…The dose of BT-A injected per hand had the wide range of 10 to 300 units, and no injection site stands out among these studies as a disproportional cause of complications. However, Fregene et al 11 noticed that most of their cases of muscle weakness occurred when injections Subjective patient reported outcomes 23 1,2,4,5,[10][11][12][13][14]16,17,21,23,[27][28][29]32,33,[35][36][37]40,42,46 VAS 22 9,11,16,[18][19][20]22,[24][25][26][29][30][31]34,[37][38][39]41,[43][44][45][46] Ulcer healing 21 4,[11]…”

Section: Vas Ulcer Healing Capillaroscopy 1 Momentioning

confidence: 99%

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The Use of Botulinum Toxin in Raynaud Phenomenon

2023

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Background Raynaud phenomenon (RP) is a vasospastic condition of the digits that can be primary or secondary to systemic disease. Symptoms are triggered by cold or stress and can cause pain and skin color changes. The chronic ischemia may lead to necrosis, ulceration, and amputation. There are no Food and Drug Administration–approved treatments and cases refractory to pharmacologic and surgical treatments are difficult to control. Local botulinum toxin injections have been increasingly used in the treatment of Raynaud disease and have shown promising results. Aim of the study To examine the outcomes, techniques, and complications of botulinum toxin use for the treatment of Raynaud disease. Methods The PubMed database was queried using “botulinum toxin” AND “Raynaud phenomenon” as title key words. Preferred reporting items for systematic reviews and meta-analysis criteria were used. Additional articles were selected while reviewing the references of the articles from PubMed. No time restrictions were followed. Articles of all languages were included. Articles were analyzed for study type, demographics, diagnosis/inclusion criteria, treatment methods, outcome measures, length of follow-up, results, and complications. A positive outcome was defined as subjective improvement in symptoms and/or improvement in the outcome measures. A poor outcome was defined as harm done to the patient by the injection that would not have occurred otherwise. Results Forty-two clinical studies describing the use of botulinum toxin for Raynaud's phenomenon were found. A total of 425 patients with primary or secondary Raynaud's were treated, with ages ranging from 14 to 91 years. There were 342 women and 81 men, with a female-to-male ratio of 38:9. Outcomes were positive in 96.2% of patients. There were 14.2% of the studies that reported 3.5% of all patients showing no subjective improvement. A single study reported a poor outcome for 1 patient. There were 40.5% of the studies that reported complications, affecting 20.2% of all patients. The most frequently reported complication was transient hand weakness, affecting 44.2% of patients with complications and 8.9% of total patients. Weakness resolved in hours to months after injection. Pain at the injection site lasting minutes to days was reported in 40.7% of patients with complications, and 8.2% of total patients. Conclusions Botulinum toxin treatment for RP is effective. Complications are minor and self-limiting.

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Section: Resultsmentioning

confidence: 99%

Section: Positive Resultsmentioning

confidence: 99%

Section: Injection Techniquesmentioning

confidence: 99%

Section: Injection Techniquesmentioning

confidence: 99%

Section: Vas Ulcer Healing Capillaroscopy 1 Momentioning

confidence: 99%

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The Use of Botulinum Toxin in Raynaud Phenomenon

2023

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Role of the vascular surgeon in the treatment of secondary Raynaud’s phenomenon, literature review and endovascular management proposal

Achurra-Godínez,

Sierra-Juarez,

Lacayo-Valenzuela

2023

Int Surg J

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Raynaud´s phenomenon is a very common condition, usually little investigated due to its benign nature, however, when talking about Secondary Raynaud’s phenomenon, the situation can become very serious and even compromise the integrity of the extremities, it is then when it is important to know the multidisciplinary team that can and should intervene, as well as the treatment alternatives both medical, surgical and endovascular, this is where the extremely important role of the vascular surgeon in this condition comes in. A search was carried out in the main search engines of medical research (Pubmed, Ebsco host, Clinical key, Cochrane, and Springer Link) focused on the pathophysiology, diagnosis and treatment of Raynaud’s phenomenon, finding most of the bibliography in dermatology, rheumatology, plastic surgery and to a lesser extent angiology and vascular surgery. And share the experience we have had in endovascular management and its long-term results. We select about 45 papers from different topics for made this recompilation trying to include the different approaches by specialty and emphasize in the management that the vascular surgeon could offer and present the experience obtained in some patients in our hospital. Secondary Raynaud´s phenomenon can be a mutilating condition that is usually managed exclusively by rheumatology and dermatology, however in selected (complex) cases the intervention of the vascular surgeon can make a difference in the integrity of the limbs and the quality of life of our patients.

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Novel Combined Approach for Digital Necrosis Secondary to Raynaud’s Phenomenon

Cited by 2 publications

References 26 publications

The Use of Botulinum Toxin in Raynaud Phenomenon

The Use of Botulinum Toxin in Raynaud Phenomenon

Role of the vascular surgeon in the treatment of secondary Raynaud’s phenomenon, literature review and endovascular management proposal

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