Melbourne Hand Surgery 

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Latest news: Elective hospital surgeries are now unrestricted and we have options to book prior to Christmas. You no longer need to have a COVID test prior to hospital admission. Dr Tomlinson is operating at The Avenue and Glenferrie Private; Epworth Cliveden is indefinitely closed at this time. Our offices will be closed from 21 December 2020 until 10 January 2021 inclusive.

All suitable consultations at Melbourne Hand Surgery are currently conducted via telehealth at our dedicated virtual clinic to maximise patient and staff safety. We have implemented enhanced hygiene measures in our rooms including acrylic screens, masks, hand sanitiser, face shields and physical distancing-related changes. We require that all patients provide a referral prior to booking an appointment so that urgent and emergency conditions can be identified and managed in a timely manner, and so that our surgeons can assess your suitability for a telehealth appointment and identify any further information or tests that might be required before your consultation.

Victorians are in this together and together we will get through this. Thank you for your understanding as our community works through these unprecedented times together (last updated: 24 November 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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