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Adjuvant spinal cord stimulation improves wound healing of peripheral tissue loss due to steal syndrome of the hand: clinical challenge treating a difficult case
Author(s) -
De Caridi Giovanni,
Massara Mafalda,
Benedetto Filippo,
Tripodi Paolo,
Spinelli Francesco,
David Antonio,
Grande Raffaele,
Butrico Lucia,
Serra Raffaele,
de Franciscis Stefano
Publication year - 2016
Publication title -
international wound journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.867
H-Index - 63
eISSN - 1742-481X
pISSN - 1742-4801
DOI - 10.1111/iwj.12233
Subject(s) - medicine , peripheral , adjuvant , spinal cord stimulation , wound healing , stimulation , spinal cord stimulator , surgery
Hand ischaemia due to arterial steal syndrome is an infrequent, but potentially serious complication of arteriovenous fistula ( AVF ) for haemodialysis. We present a case of hand ischaemia caused by steal syndrome in a 69‐year‐old haemodialysis patient, 10 months after a brachiobasilic fistula creation. The patient underwent multiple operations without resolution of hand pain and tissue loss. The implantation of an adjuvant cervical spinal cord stimulator allowed the patient to obtain complete hand pain relief and wound healing. Probably, the diffuse microangiopathy typical of haemodialysis patients could be responsible for the persistence of ischaemic signs and symptoms after a surgical revascularisation. The effect of sympathetic blockade and the subsequent improvement of the arterial blood flow and tissue oxygenation because of spinal cord stimulation ( SCS ) can be useful to achieve complete ischaemic pain relief in order to enhance wound healing and to limit the tissue loss. In conclusion, the association of cervical spinal cord stimulation and surgical revascularisation could represent a valid option to treat a critical upper limb ischaemia following steal syndrome due to AVF.