Abstract
In severely ischemic hands where the microcirculation is not amenable to reconstruction, there is evidence that palmar digital sympathectomy has salutary effects. This report describes the case of a patient with a painful, ulcerated, ischemic hand secondary to ulnar artery stenosis, generalized vasospasm and intimal hypertrophy that resulted from cold injury. Surgical treatment involved an interpositional vein graft replacing a thrombotic segment of the ulnar artery and concomitant palmar digital sympathectomy. The coupling of these two microvascular procedures completely relieved the patient's symptoms, increased total blood flow and improved the vascular function of the hand. The combination of reconstruction of an occluded vessel with peripheral sympathectomy in treating difficult cases of ischemic hand injury is recommended.
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