Article
Use of botulinum toxin a in management of a complex volar thumb wound in a systemic sclerosis patient: Case report
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Authors
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Ayana Crichlow
- University of the West Indies, Bridgetown, Barbados
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: Patients with systemic sclerosis endure poor wound healing especially in the hand and digit fingertip wounds are a common problem. This disease process typically is associated with immune-mediated vascular injury and unopposed vasoconstriction of the hand's small vessels. There is limited data on the efficacy of botulinum toxin A in the non-surgical treatment of digit fingertip wounds. But, it is still thought of as a viable pharmaceutical option. Its use in systemic sclerosis patients for healing of digit wounds not on the fingertip is undocumented. This case report showcases botulinum toxin A unconventional use for a thumb wound in a systemic sclerosis patient.
The objective was to assess wound healing and monitor for immediate, early and late effects of botulinum toxin A use on digit wounds in a systemic sclerosis patient.
Methods: Informed consent was taken. A median nerve block was performed. 100u of botulinum toxin A was reconstituted and 20u was injected around the thumb radial and ulnar digital nerve (10u each), at the level of the right thumb A1 pulley.
Right thumb SpO2 was taken before and immediately after the procedure. The patient was followed clinically for wound healing and side effects of Botulinum toxin A over the next 9 months.
Results and Conclusions:
This patient presented with a 3 x 2.5 cm wound over the volar aspect of her right thumb interphalangeal joint and an exposed flexor pollicis longus tendon was seen in the base of the wound. SpO2 before and immediately after botulinum toxin A injection was 88% and 94% respectively. The patient experienced pain relief in 24 hours. Complete wound healing was noted 25 days after injection. 54 days after injection full thumb range of motion with Kapandji score 10 was noted. No side effects of botulinum toxin A were identified (Figure 1 [Fig. 1]).
Botulinum toxin A may be used as an alternative treatment option in healing of wounds to the digits of systemic sclerosis patients where:
- 1.
- Surgery is contraindicated
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- Delay in surgery is expected
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- A salvage option where amputation is highly likely [1].
References
- 1.
- Neumeister MW. Botulinum toxin type A in the treatment of Raynaud’s phenomenon. J Hand Surg Am. 2010 Dec;35(12):2085-92.
