Periarterial Sympathectomy of the Foot for the Treatment of Necrotizing Raynaud's Phenomena
01 December 2008 (online)
Patients with critical peripheral vascular disease and nonhealing toe ulcers secondary to collagen vascular disease often require toe amputation when nonsurgical measures fail to control their symptoms. The aim of this study was to evaluate the effectiveness of periarterial sympathectomy (PAS) of the foot/ankle in patients with unreconstructable vaso-occlusive disease and nonhealing digit ulcers unresponsive to nonsurgical measures. Five patients (seven feet and nine toe ulcers) were treated with PAS of their involved foot and followed for a minimal of 3 years (3 to 7 years). The technique included PAS of the dorsalis pedis, posterior tibial and anterior tibial arteries. Eight toe ulcers healed uneventfully within 3 months after surgery. Only one patient developed a new ulcer 5 years after PAS. The mean visual analog pain scale improved from 5.7 to 1 (p < 0.03). The mean Wake Forest University (WFU) scale improved from 1.8 to 0.5 (p = 0.07). There was no change in the WFU numbness score or the McCabe Cold sensitivity scale. The results suggest that foot/ankle PAS is a beneficial salvage treatment option for patients with non-reconstructible, vaso-occlusive disease that ameliorates foot symptoms, facilitates healing of toe ulcerations, and reduces the incidence of toe amputations.
Foot ulcer - peripheral vascular disease - periarterial sympathectomy
- 1 La Montagna G, Baruffo A, Tirri R, Buono G, Valentini G. Foot involvement in systemic sclerosis: a longitudinal study of 100 patients. Semin Arthritis Rheum. 2002; 31 248-255
- 2 Agarwal J, Zachary L. Digital sympathectomy of the lower extremity: a novel approach to toe salvage. Plast Reconstr Surg. 2005; 116(4) 1098-1102
- 3 Sari-Kouzel H, Hutchinson C E, Middleton A et al.. Foot problems in patients with systemic sclerosis. Rheumatology (Oxford). 2001; 40 410-413
- 4 Koman L A, Smith B P, Pollock F E, Smith T L. The microcirculatory effects of periarterial sympathectomy. J Hand Surg [Am]. 1995; 20 709-717
- 5 Ruch D S, Holden M, Smith B P, Smith T L, Koman L A. Periarterial sympathectomy in scleroderma patients: intermediate-term follow-up. J Hand Surg [Am]. 2002; 27 258-264
- 6 Koman L A, Smith B P, Smith T L. Stress testing in the evaluation of upper extremity perfusion. Hand Clin. 1993; 9 59-83
- 7 Teasdall R D, Smith B P, Koman L A. Complex regional pain syndrome (reflex sympathetic dystrophy). Clin Sports Med. 2004; 23 145-155
- 8 Melzack R. The short-form McGill Pain Questionnaire. Pain. 1987; 30 191-197
- 9 McCabe S J, Mizgala C, Glickman L. The measurement of cold sensitivity of the hand. J Hand Surg [Am]. 1991; 16 1037-1040
- 10 Tomlinson L. Case study to illustrate a multidisciplinary approach to a case of critical limb ischemia and the role of chemical lumbar sympathectomy. J Tissue Viability. 2000; 10 140-143
- 11 Flatt A E. Digits artery sympathectomy. J Hand Surg [Am]. 1980; 5 550-556
- 12 Troum S J, Smith T L, Koman L A, Ruch D S. Management of vasospastic disorder of the hand. Clin Plast Surg. 1997; 24 121-132
- 13 Wilgis E FS. Digital sympathectomy for vascular insufficiency. Hand Clin. 1985; 1 361-367
Zhongyu Li, M.D. , Ph.D.
Assistant Professor, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Blvd.
Winston-Salem, NC 27157-1070