Stoehr Jenna R, Kearney Aaron M, Massie Jonathan P, Ko Jason H, Dumanian Gregory A
Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill.
Plast Reconstr Surg Glob Open. 2021 May 21;9(5):e3582. doi: 10.1097/GOX.0000000000003582. eCollection 2021 May.
Symmetric peripheral gangrene (SPG) affects peripheral tissues of critically ill patients and can have severe disfiguring and debilitating effects. It can occur in the setting of multiple conditions, and it is associated with the use of vasopressors. There are no evidence-based treatments available for patients who develop SPG. Botulinum toxin has emerged as a potential therapy in vasospastic disorders, and we hypothesized that it may be used in the treatment of tissue ischemia in critically ill patients on vasopressors. We present a case of a patient who developed vasopressor-associated SPG and who experienced complete resolution after local injection with botulinum toxin. While the action of botulinum toxin on skeletal muscle is best understood, it has also been demonstrated to attenuate the release of multiple vasoconstrictive factors that impact vascular smooth muscle and modulate calcium and nitric oxide. These effects may result in vasodilation and improvement of cutaneous ischemia when injected locally. Clinicians may consider this local therapy in the treatment of vasopressor-associated symmetric peripheral gangrene.
对称性外周坏疽（SPG）影响危重症患者的外周组织，可产生严重的毁容和致残后果。它可在多种情况下发生，且与血管加压药的使用有关。对于发生SPG的患者，目前尚无循证治疗方法。肉毒杆菌毒素已成为血管痉挛性疾病的一种潜在治疗方法，我们推测它可用于治疗使用血管加压药的危重症患者的组织缺血。我们报告一例发生血管加压药相关SPG的患者，在局部注射肉毒杆菌毒素后完全康复。虽然肉毒杆菌毒素对骨骼肌的作用已得到充分了解，但也已证明它能减少多种影响血管平滑肌并调节钙和一氧化氮的血管收缩因子的释放。局部注射时，这些作用可能导致血管舒张并改善皮肤缺血。临床医生在治疗血管加压药相关的对称性外周坏疽时可考虑这种局部治疗方法。
