Arrault M, Vignes S
Unité de Lymphologie, Hôpital Cognacq-Jay, 15, rue Eugène Miron, 75015 Paris.
Ann Dermatol Venereol. 2006 Oct;133(10):769-72. doi: 10.1016/s0151-9638(06)71040-7.
Puffy hand syndrome is a complication of intravenous drug abuse, which has no current available treatment. Arm and forearm edema are voluminous and cause functional and aesthetic disturbances. We report two cases successfully treated by low-stretch bandages.
A 40-year-old man and a 34-year-old woman, both intravenous drug users, with puffy hand syndrome were hospitalized for 11 days. Treatment included daily multilayer bandaging. Lymphedema volumes calculated by utilizing the formula for a truncated cone decreased by 16% on the left side and 12% on the right side for the first patient and 31 and 17% for the second. Hand circumference decreased 4.3 cm on the left side and 3.2 cm on the right side in case 1, and 2.5 cm and 1.9 cm respectively for case 2. The patients were taught self-bandaging techniques during their hospital stays. Elastic gloves were fitted at the end of treatment. Reduction of lymphedema volume remained stable after 18 months in one patient while for the second patient further treatment and hospitalization were required due to poor compliance.
The pathogenesis of this edema is probably multifactorial: venous, lymphatic insufficiency and the direct toxicity of injected drugs. Lymphedema treatment currently consists of low-stretch bandaging and wearing elastic garments, which is effective in decreasing the volume of puffy hand syndrome.
手部肿胀综合征是静脉药物滥用的一种并发症，目前尚无有效治疗方法。手臂和前臂水肿严重，会导致功能和美观方面的问题。我们报告了两例通过低弹性绷带成功治疗的病例。
一名40岁男性和一名34岁女性，均为静脉药物使用者，因手部肿胀综合征住院11天。治疗包括每日进行多层包扎。利用截头圆锥体公式计算的淋巴水肿体积，第一位患者左侧减少了16%，右侧减少了12%；第二位患者左侧减少了31%，右侧减少了17%。病例1中，手部周长左侧减少了4.3厘米，右侧减少了3.2厘米；病例2中，分别减少了2.5厘米和1.9厘米。在住院期间，教会了患者自我包扎技术。治疗结束时佩戴了弹力手套。一名患者在18个月后淋巴水肿体积的减少保持稳定，而另一名患者由于依从性差，需要进一步治疗和住院。
这种水肿的发病机制可能是多因素的：静脉、淋巴功能不全以及注射药物的直接毒性。目前淋巴水肿的治疗包括低弹性绷带包扎和穿戴弹力衣物，这对减少手部肿胀综合征的体积有效。
