Surgical Management for Raynaud’s Phenomenon of the Hands: Indications, Methods, Postoperative Care, and Algorithm

Abstract

Introduction: Raynaud’s phenomenon of the hands is a progressive disease, and it often results in fatal ischemia. Medical treatment has been the main modality of treating Raynaud’s phenomenon, but it aims to control symptoms, not to solve the underlying causes of ischemia. The purpose of this study is to analyze cases of Raynaud’s phenomenon treated through surgical management and to introduce an appropriate surgical approach for Raynaud’s phenomenon.

Methods: A total of 137 patients (238 hands) with Raynaud’s phenomenon treated with surgical interventions, including sympathectomy, microsurgical vascular reconstruction, and decompression procedures, between January 2008 to December 2018 at the Department of Plastic Surgery of Hanyang University Medical Center were reviewed retrospectively. Causes, surgical interventions and outcomes, recurrence, and secondary procedures were evaluated.

Results: The major cause of Raynaud’s phenomenon was autoimmune disease, accounting for 78 of 137 patients (56.9%). Of the 238 hands, 85 (35.7%) underwent only periarterial sympathectomy, 139 (58.4%) underwent microsurgical vascular reconstruction, and 130 (54.6%) underwent a combined decompression procedure. All 238 hands showed improvements of ischemic symptoms postoperatively. Total wound healing in the hands with ulceration and necrosis was observed in 112 of 118 hands (94.9%). Vascular re-occlusion in vascular reconstruction cases occurred in 25 of 153 hands (16.3%). Symptomatic recurrence was observed in 108 hands (45.4%), and the mean period to recurrence was 21.3 months. Autoimmune disease was proven to be significant risk factor for symptomatic recurrence in multivariable logistic regression (adjusted odds ratio, 4.272; P<0.001)

Conclusion: This study shows that surgical management of Raynaud’s phenomenon is effective and reliable for improving ischemia of the hand. Underlying autoimmune disease should be managed appropriately to prevent recurrence. We propose a comprehensive algorithm to optimize the surgical treatment of Raynaud’s phenomenon.