Taylor L M, Baur G M, Porter J M
Ann Surg. 1981 Apr;193(4):453-61. doi: 10.1097/00000658-198104000-00010.
Available evidence indicates that about one third of all patients presenting with localized finger gangrene developed the condition due to intrinsic occlusions of the small arteries of the hand and fingers caused by one of a variety of systemic diseases. We have treated 35 such patients in the past seven years. A variety of diagnostic tests allowed the establishment of the diagnosis of connective tissue disease in 14 patients, hypersensitivity angiitis in 13 patients, arteriosclerosis in five patients, and myeloid metaplasia, calciphylaxis, and carcinoma in one patient each. Treatment with cold and tobacco avoidance, vasodilators, and local debridement produced good results without amputation in 30 patients. Five patients required partial phalangeal amputation. These results suggest that appropriate diagnostic tests will allow an accurate diagnosis in all patients, and that the natural history is that of spontaneous improvement without major tissue loss. In our experience, surgical sympathectomy plays no role in the treatment of these patients.
现有证据表明，所有出现局限性手指坏疽的患者中，约三分之一是由多种全身性疾病之一导致手部和手指小动脉的内在闭塞而引发该病症。在过去七年中，我们治疗了35例此类患者。通过各种诊断测试，确诊14例为结缔组织病，13例为过敏性血管炎，5例为动脉硬化，另有1例分别为骨髓化生、钙质沉着症和癌。30例患者通过保暖、戒烟、使用血管扩张剂和局部清创治疗，未行截肢即取得了良好效果。5例患者需要进行部分指骨截肢。这些结果表明，适当的诊断测试能够对所有患者进行准确诊断，其自然病程是在无重大组织损失的情况下自发改善。根据我们的经验，手术交感神经切除术对这些患者的治疗并无作用。
