Segreto Francesco, Marangi Giovanni Francesco, Cerbone Vincenzo, Persichetti Paolo
From the Department of Plastic, Reconstructive and Aesthetic Surgery, "Campus Bio-Medico di Roma" University, Rome, Italy.
Ann Plast Surg. 2016 Sep;77(3):318-23. doi: 10.1097/SAP.0000000000000715.
Raynaud phenomenon (RP) is a transient digital ischemia that occurs after exposure to cold temperature or emotional distress. It presents with a triphasic course: the initial white phase is followed by cyanotic discoloration and, subsequently, erythema. The attacks may be associated with pain, paresthesia, and complicate with nonhealing ulceration often leading to amputation. To date, there are no clear-cut therapeutic guidelines and many medications are used off-label. Encouraging results were reported with the use of botulinum neurotoxin-A (BoNT-A). However, there is still ongoing debate regarding indications, contraindications, best injection technique, and mechanism of action. The aim of this study was to address these issues by providing an up-to-date and detailed overview of the use of BoNT-A in RP.A PubMed database search was conducted. The available studies and techniques were evaluated and compared.The search yielded a total of 29 studies. Ten papers, published between 2004 and 2014, were considered relevant. A total of 128 patients underwent BoNT-A injections. Seventy-five percent to 100 % of the patients reported pain reduction after treatment. Healing of ulcers was reported in 75% to 100% of the affected patients. The most common complication was temporary hand weakness, with an average incidence of 14.1%. Injections targeting the neurovascular bundle at or slightly proximal to the A1 pulley were the most commonly performed.Botulinum neurotoxin-A injection proved to be a valid approach in both primary and secondary RP. The available evidence shows the achievement of both symptomatic and functional improvements in this debilitating condition. However, the patient should be adequately informed about the risk of transient hand weakness.
雷诺现象（RP）是一种在暴露于寒冷温度或情绪困扰后发生的短暂性手指缺血。它呈现出三相病程：最初的白色阶段之后是青紫变色，随后是红斑。发作可能伴有疼痛、感觉异常，并常并发不愈合溃疡，常导致截肢。迄今为止，尚无明确的治疗指南，许多药物都是超说明书使用。使用肉毒杆菌神经毒素A（BoNT - A）报告了令人鼓舞的结果。然而，关于适应证、禁忌证、最佳注射技术和作用机制仍存在争议。本研究的目的是通过提供关于BoNT - A在RP中应用的最新详细概述来解决这些问题。进行了PubMed数据库搜索。对现有研究和技术进行了评估和比较。搜索共产生29项研究。2004年至2014年间发表的10篇论文被认为相关。共有128例患者接受了BoNT - A注射。75%至100%的患者报告治疗后疼痛减轻。75%至100%的受影响患者报告溃疡愈合。最常见的并发症是暂时性手部无力，平均发生率为14.1%。最常进行的注射是针对A1滑车或其稍近端的神经血管束。肉毒杆菌神经毒素A注射被证明是原发性和继发性RP的有效方法。现有证据表明，在这种使人衰弱的疾病中，症状和功能都得到了改善。然而，应充分告知患者暂时性手部无力的风险。
