Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with severe, refractory Raynaud’s phenomenon characterized by episodic digital ischemia, color changes (pallor, cyanosis, rubor), and persistent pain despite optimal medical management (calcium channel blockers, phosphodiesterase inhibitors). History of non-healing digital ulcers, trophic changes, and significant functional impairment. Patient is now seeking evaluation for digital sympathectomy due to failure of conservative therapy and high risk of tissue loss.
Clinical Examination Findings
Physical examination reveals cold, clammy digits with evidence of capillary refill delay (>3 seconds). Presence of chronic digital pitting scars, distal pulp atrophy, and active necrotic ulcers on [specify digit]. Allen’s test demonstrates compromised radial/ulnar collateral flow. Doppler ultrasound confirms diminished digital artery flow velocities and monophasic waveforms. No evidence of proximal large-vessel occlusive disease.
Treatment Protocol
Plan: Digital sympathectomy indicated for refractory Raynaud’s. Procedure involves microsurgical periarterial stripping of the digital arteries to interrupt sympathetic vasoconstrictive input. Pre-operative optimization includes cessation of smoking and optimization of systemic vasodilators. Post-operative care includes warming protocols, anti-platelet therapy, and wound care for existing ulcers.