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Back to 2017 Scientific Program ePosters Botox Salvage of Post-traumatic Digitial Ischemia in the Hand Gregory Borah, MD FACS West Virginia University, Morgantown, WV Botox Salvage of Post-traumatic Digitial Ischemia in the Hand. Introduction: Effective use of botulinum toxin A (Botox) to improve blood flow in difficult to manage chronic vasospastic disorders of the hand, such as in Reynaunds disease and scleroderma has been appreciated for several years. ItŐs efficacy in salvaging impending ischemic loss in digits in acute traumatic and semi-acute injury has not been previously reported. Materials and Methods: From February 2015 to June 2016, nine patients (9) at our Level 1 Trauma Center presented to the hand surgery service with early or late ischemic injury and vascular compromise to one or more fingers as a result of crush injury, direct drug injection or proximal arterial injury from use of the radial artery in catheterization by Interventional Radiology. This group was precluded from treatment with intravenous thrombolytic agents because of poly-trauma, contraindicated medical illness, or pregnancy. Prior to December 2015, all patients with vascular compromise (mottling, coolness to touch, diminished capillary refill, resting pain) were treated with a standard protocol of aspirin, protective dressings and a warm milieu. Starting in January 2016 patients with these characteristics were treated with injection of 80-100 units of Botox into the palm in addition to our previous standard protocol. Results: From February to December 2015, six (6) patients with obvious vascular compromise (mottling, coolness to touch, diminished capillary refill, resting pain) to one or more fingers and hand were evaluated and treated with a protocol of aspirin, protective dressings and a warm milieu. With this regimen 5 of 6 patients (83% loss) went on to partial or complete amputation of necrotic digits. The one patient who retained their affected finger has continued with ischemic pain (5/10 score) in the digit. Starting in January 2016 three (3) patients with ischemic sequelae of trauma were treated with injection of 80-100 units of Botox into the palm, in addition to our previous standard protocol. All digits (4 fingers in 3 pts) were preserved (100% salvage). One patient has persistent digital pain (3/10 score) with a warm, pink finger. Conclusion: 1) In the acute or sub-acute phase of traumatic vascular hand injury Botox injection can markedly increase digital salvage rates. 2) Increased perfusion resulting from Botox injection appears to improve post injury pain scores. 3) Early consideration and use of Botox in traumatic injury is now part of our standard approach to impending ischemic necrosis in the hand. Back to 2017 Scientific Program ePosters |
