Botulinum toxin type A: a treatment option for digital ischemia in patients with Raynaud's phenomenon.
OBJECTIVE
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.
Fregene
Alero
A
Division of Plastic Surgery, Henry Ford Hospital, Detroit, MI, USA.
Ditmars
Donald
D
Siddiqui
Aamir
A
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D007267:Injections; D007511:Ischemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D010858:Pigmentation; D011928:Raynaud Disease / Q000188:drug therapy*; D012189:Retrospective Studies; D012883:Skin Ulcer / Q000188:drug therapy / Q000209:etiology; D014945:Wound Healing
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; D010100:Oxygen