Chicago, Ill. From the Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center.
Plast Reconstr Surg. 2014 May;133(5):1109-1118. doi: 10.1097/PRS.0000000000000104.
Raynaud phenomenon causes progressively decreasing blood flow to the extremities, resulting from an imbalance between vasoconstriction and vasodilation. Treatment options include biofeedback, phosphodiesterase inhibitors, calcium channel inhibitors, botulinum toxin injection, or surgical sympathectomy. The authors propose fat grafting to the hands as a method to delay progression of the disease.
Indications included symptomatic Raynaud phenomenon with failure of previous management. Fat is harvested from abdominal depots. Approximately 30 ml of decanted fat is injected by means of blunt cannulae: 10 to 15 ml in the dorsum of the hand, 2 to 3 ml in the snuffbox, 1 to 2 ml in each dorsal webspace, 3 to 4 ml along the superficial palmar arch, 1 to 2 ml in volar webspaces 2 to 4, and 2 to 3 ml in the first webspace. Patients underwent preoperative and postoperative laser speckle imaging study to assess changes in perfusion.
A total of 13 patients were treated (21 hands). Twelve patients had undergone prior botulinum toxin injection, and 11 patients had prior sympathectomies. Findings included reduced pain (average reduction, 6.86 of 10 to 2.38 of 10), fewer cold attacks, improved skin and soft-tissue texture, decrease in ulcerations, and patient-reported improved function. Three patients had no changes. Increased blood flow per imaging was noted in five of 11 hands tested. Six patients had decreased readings on laser imaging. None of the laser speckle imaging changes were statistically significant, and they did not correlate clinically. There were no major complications.
Preliminary results of fat grafting to the hands of patients with Raynaud phenomenon revealed improved symptomatology with evidence suggestive of measurably increased perfusion in some cases. Fat grafting may benefit the management of this patient population.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
雷诺现象导致四肢血流逐渐减少，这是由于血管收缩和血管扩张之间的失衡所致。治疗选择包括生物反馈、磷酸二酯酶抑制剂、钙通道抑制剂、肉毒杆菌毒素注射或手术交感神经切除术。作者提出向手部注射脂肪移植作为一种延缓疾病进展的方法。
适应证包括以前治疗失败的有症状的雷诺现象。从腹部储存库中提取脂肪。通过钝套管注射约 30 毫升的倾析脂肪：10 至 15 毫升在手部背侧，2 至 3 毫升在鼻烟盒，1 至 2 毫升在每个背侧网间空间，3 至 4 毫升在手背动脉弓上，1 至 2 毫升在掌侧网间空间 2 至 4，以及 2 至 3 毫升在第一掌间空间。患者接受术前和术后激光散斑成像研究以评估灌注变化。
共治疗了 13 名患者（21 只手）。12 名患者接受了肉毒杆菌毒素注射，11 名患者接受了交感神经切除术。发现包括疼痛减轻（平均减轻，从 10 分中的 6.86 分降至 10 分中的 2.38 分）、冷攻击减少、皮肤和软组织质地改善、溃疡减少以及患者报告的功能改善。3 名患者没有变化。在 11 只测试的手中，有 5 只观察到血流量增加。6 名患者的激光成像读数降低。激光散斑成像变化均无统计学意义，且与临床无关。没有主要并发症。
雷诺现象患者手部脂肪移植的初步结果显示，症状改善，在某些情况下有证据表明灌注可测量增加。脂肪移植可能有益于这类患者人群的管理。
临床问题/证据水平：治疗，IV。
