Successful treatment of digital ischemic ulcer with stellate ganglion blockade

Abstract

Stellate ganglion blockade (SGB) could be used for the treatment of sympathetic dependent circulatory insufficiency in the upper limb. The sympathetic blockade produces relaxation of the upper extremity arteries, which increases blood flow of capillary and helps to relieve ischemia then facilitate peripheral wound healing. We report a patient with refractory ischemic ulcer in distal phalanges, who was successfully treated with SGB. A 36-year-old female patient admitted in department of plastic surgery for contact burn wound in the right hand. There were 2nd degree burn in the right 2nd through 5th fingertips ( Fig. 1 ). Despite of 2 months of dressing, digital burn wound was not healed and seems to be refractory. Suspecting vascular insufficiency, upper extremity angiography was done. It revealed decreased perfusion in 2nd through 5th fingers ( Fig. 2 ) and digital fingertip wounds were diagnosed as ischemic ulcer. For the improvement of circulation in her vulnerable fingers, physical modalities were applied and 100 mg of aspirin was prescribed daily. The sympathetic skin response was conducted for the evaluation of sympathetic nerve system. It showed no response in right hand and foot. We planned SGB to increase blood flow at the fingers and SGB was done under ultrasonography, twice per week for 3 weeks. The follow-up angiography showed significant improvement of fingertip perfusion ( Fig. 3 ). Consequently fingertip wounds were completely healed ( Fig. 1 ). Finally, she could achieved independent ADL with her hand. The SGB can be effective on improving blood flow for healing of ischemic ulcer in the fingertips. We suggest the SGB could be an alternative option to overcome intractable condition.