Centro de Estudios Médicos e Investigaciones Clínicas (C.E.M.I.C.), Buenos Aires, Argentina.
Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, México.
Vasc Endovascular Surg. 2021 Oct;55(7):766-771. doi: 10.1177/15385744211005663. Epub 2021 Apr 19.
The presence of severe Raynaud's Phenomenon (RP), with permanent pain or digital necrosis is a rare condition. Cervical sympathectomy or distal sympathectomy or A botulinum toxin have demonstrated efficacy after medical treatment failure. We report the case of a 38-year-old female patient with an acute onset of severe RP in both hands secondary to systemic sclerosis. Medical treatment failed, so a novel approach by a combination of a modified distal sympathectomy and injection of A botulinum toxin on digital neuromuscular bundles was performed. Remission of the pain occurred immediately after the procedure and 45 days later she had complete healing of the digital wounds and recovered full mobilization of both hands. The patient remained asymptomatic 6 month after the procedure, and a Doppler ultrasound showed tri-phasic flows distal to the surgical site. This novel technique is described, and a brief review of the literature is performed.
严重雷诺现象（RP）的存在，伴有持续性疼痛或指端坏死是一种罕见的情况。颈交感神经切除术或远端交感神经切除术或 A 型肉毒毒素在药物治疗失败后已被证明具有疗效。我们报告了一例 38 岁女性系统性硬化症患者，双手急性发生严重 RP。药物治疗失败后，我们采用改良的远端交感神经切除术和 A 型肉毒毒素注射到指神经肌束的联合新方法进行治疗。术后疼痛立即缓解，45 天后，指端伤口完全愈合，双手完全恢复活动。术后 6 个月患者无症状，多普勒超声显示手术部位远端呈三相血流。本文介绍了这种新的技术，并对文献进行了简要回顾。
