Raynaud's
phenomenon is a disorder of blood circulation in the fingers and toes
(and less commonly of the ears and nose). It affects small
arterial vessels causing them to collapse due to exposure to cold,
emotional
stress or vasoconstrictive agent (medication or smoking).
Abnormal
nerve control of the blood-vessel diameter causes small capillary to
collapse (A). Finger colour first turns white (B) due to lack of blood
supply,
then blue (C) due to lack of oxygen. Frequent attacs can lead to
serious lack of tissue oxygen at fingertips and thrombosis
that
can result in tissue death - gangrene (see picture below).
Raynaud's phenomenon (RF) can be seen also
with: rheumatoid
arthritis, scleroderma,
lupus erythematosus, frostbite,
hormone imbalance and cancer.
Case file: Gangrene of
left hand distal phalange due to
Raynaud’s syndrome and scleroderma
A 69
years old female
with 60 years of
Raynaud's syndrome and scleroderma. She had 3 open ulcers on the
fingers of the
left hand and gangrene on the index finger. She had cramps, weakness,
partial
numbness and strong pain in both hands especially during night which
was managed
with medications, however side effects included constipation/diarrhea
and stomach problems.
She also suffered from pulmonary hypertension.
Microvascular
assessment showed moderate to severe ischemia and hypoxia (reduced
circulation
and tissue oxygen levels respectively) in LH and mild decrease in RH.
Reduced
levels of both oxygenation and blood circulation were noted also in
both feet,
as well as partial loss of sensitivity (neuropathy in booth feet).
Treatment protocol
Following
microvascular assessment of both hands
and legs, she initiated 40 consecutive hyperbaric sessions in oxygen
compressed monoplace chamber. Treatment session was 90 min long at
pressure 2 –
2.4 ATA (depending on the lung auscultation). Progress of healing was
monitored
with microvascular assessment.
Treatment outcome
After 40 sessions two ulcers closed and the gangrene
turned into an ulcer with clear demarcation of the improved circulation
and
visible granulation. Pain medication was discontinued, swelling and
cramping was
reduced and she had better function of both hands as well as improved
sensitivity in both hands and feet. Lung function also improved and she
had more
energy for daily activities, better sleep and better tolerance of cold
temperature and Raynaud’s attacks.
With overall improved cardiopulmonary status and
circulation her surgeon decided to perform a saphenous
vein
graft from her left leg to her left wrist where there is
still some
occlusion reducing proper blood flow.
Following surgery she returned for additional
sessions for better healing and faster recovery.
Before hyperbaric sessions
Initial evaluation
After 40 hyperbaric sessions
