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Fat Grafting to the Hand in Patients with Raynaud Phenomenon: A Novel Therapeutic Modality

Bank, Jonathan M.D.; Fuller, Sam M. M.D.; Henry, Ginard I. M.D.; Zachary, Lawrence S. M.D.

Plastic and Reconstructive Surgery: May 2014 - Volume 133 - Issue 5 - p 1109–1118
doi: 10.1097/PRS.0000000000000104
Hand/Peripheral Nerve: Original Articles
Coding Perspective
Press Release
Best Paper

Background: Raynaud phenomenon causes progressively decreasing blood flow to the extremities, resulting from an imbalance between vasoconstriction and vasodilation. Treatment options include biofeedback, phosphodiesterase inhibitors, calcium channel inhibitors, botulinum toxin injection, or surgical sympathectomy. The authors propose fat grafting to the hands as a method to delay progression of the disease.

Methods: Indications included symptomatic Raynaud phenomenon with failure of previous management. Fat is harvested from abdominal depots. Approximately 30 ml of decanted fat is injected by means of blunt cannulae: 10 to 15 ml in the dorsum of the hand, 2 to 3 ml in the snuffbox, 1 to 2 ml in each dorsal webspace, 3 to 4 ml along the superficial palmar arch, 1 to 2 ml in volar webspaces 2 to 4, and 2 to 3 ml in the first webspace. Patients underwent preoperative and postoperative laser speckle imaging study to assess changes in perfusion.

Results: A total of 13 patients were treated (21 hands). Twelve patients had undergone prior botulinum toxin injection, and 11 patients had prior sympathectomies. Findings included reduced pain (average reduction, 6.86 of 10 to 2.38 of 10), fewer cold attacks, improved skin and soft-tissue texture, decrease in ulcerations, and patient-reported improved function. Three patients had no changes. Increased blood flow per imaging was noted in five of 11 hands tested. Six patients had decreased readings on laser imaging. None of the laser speckle imaging changes were statistically significant, and they did not correlate clinically. There were no major complications.

Conclusions: Preliminary results of fat grafting to the hands of patients with Raynaud phenomenon revealed improved symptomatology with evidence suggestive of measurably increased perfusion in some cases. Fat grafting may benefit the management of this patient population.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Coding Perspective for this article is on page 1117.

Chicago, Ill.

From the Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center.

Received for publication June 22, 2013; accepted October 18, 2013.

Presented at Plastic Surgery at the Red Sea, An Aesthetic and Reconstructive International Symposium, in Eilat, Israel, March 13 through 16, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Lawrence S. Zachary, M.D., Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, Ill. 60637, lzachary@surgery.bsd.uchicago.edu

©2014American Society of Plastic Surgeons