Melbourne Hand Surgery 

Coronavirus update: We will be closed on Wednesday 8 April, but will reopen at 8:30am on Thursday 9 April. 

Melbourne Hand Surgery has mechanisms to protect our patients and staff while we continue to provide healthcare services. All consultations are now conducted via telehealth (phone or videoconference), except where we have previously confirmed the requirement for an in-person physical examination or wound care management.  Only emergency surgery is being conducted in hospitals for the foreseeable future, in keeping with Government directives. 

Due to the change in circumstances we will be closed on Fridays until further notice. If our practice is unable to physically open for business at any point in the coming weeks or months we will communicate this to existing scheduled patients via email and SMS (please do not attempt to reply other than with Y or N to an SMS, as the automated system does not facilitate this). Incoming telephone calls and receipt of voicemail messages may be temporarily affected by such a change. We will use this website banner to update you on changes to our practice and the availability of non-urgent procedures and surgery in the weeks and months ahead. Thank you for your understanding as our entire community works through these unprecedented and rapidly evolving times together (last updated: 4 April 2020).

Botulinum toxin in vasospastic disorders of the hand

Botulinum toxin type A (BTX-A) is a new and effective therapy that can increase oxygenation, promote healing and reduce pain for patients with Raynaud's phenomenon, scleroderma, CREST syndrome, systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, Buerger's disease (Thromboangitis Obliterans) and other vasospastic disorders.

How it works

The therapy is performed as an office procedure and involves injections of 50-100 units of BTX around the neurovascular bundles in the hand. While it is not known exactly how the BTX creates its therapeutic effect, it is thought to mimic a sympathectomy, modulating the vascular and neural abnormalities of the vasospastic disorder to reduce spasm and improve blood flow.

injectionsyringehandWhile the effect of the BTX is temporary (4-6 months), the effect of the increased blood flow can last much longer and the duration of treatment effect has been reported at 13-59 months. If a patient has ulceration and pain of the digits the injections may allow complete healing of the ulcers and resolution of the pain. It takes a lesser amount of oxygenation and blood flow to maintain healthy skin, compared to the amount of oxygenation and blood flow that is required to heal ulcerated, infected or damaged tissues.

moisturising cream handsThis therapy should be used in conjunction with other conservative and medical therapies, such as smoking cessation, regular moisturiser, hand protection, appropriate wound management, and medications as directed by your rheumatologist.

Complications

Potential complications include weakness of the small muscles of the hand and pain at the injection sites.

Smoking and vasospastic disorders of the hand

smokingreducesbloodflow42percenteinsteinIf you have a vasospastic disorder of the hand it is imperative that you stop smoking. Smoking significantly reduces the blood flow to the hand. Just one cigarette is doing you major damage - a single cigarette can reduce blood flow to the fingers by 42% and cause cutaneous vasoconstriction for up to 90 minutes. The nicotine in cigaretes not only causes vasoconstriction, but smoking increases carboxyhaemoglobin, increases platelet aggregation, increases blood viscosity, decreases prostacyclin formation and decreases collagen deposition - all of which reduces healing.

It's not easy to give up smoking, please contact the professionals at Quit Victoria on 13 78 48 and keep trying until you succeed.

If you are not convinced that smoking cessation is necessary please read Brandon's story.

Clinical studies

Neumeister MW. Botulinum Toxin Type A in the Treatment of Raynaud's Phenomenon. J Hand Surg AM. 2010;35(12):2085-92

Sycha T, Graninger M, Auff E, Schnider P. Botulinum toxin in the treatment of Raynaud's phenomenon: a pilot study. Eur J Clin Invest 2004; 34:312.

Van Beek AL, Lim PK, Gear AJ, Pritzker MR. Management of vasospastic disorders with botulinum toxin A. Plast Reconstr Surg 2007; 119:217.

Review study

FRACS

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