For those who are afflicted with Raynaud phenomenon, the influence of cold weather on their hands or feet is all too well known. It is estimated that up to 2% of the population has Raynaud phenomenon in varying degrees and amount of symptoms. This is seen as vasoconstriction of part or all of the digits in cold weather or any cold stimulation. This is to be differentiated from Raynaud disease (secondary Raynaud phenomenon) in which even more severe symptoms are seen in the face of an underlying autoimmune disease. (e.g., scleroderma or lupus)
There are numerous treatments for digital symptoms of Raynaud including surgical sympathectomies, oral agents such as calcium channel blockers and injectable Botox to name a few. But their effectiveness is varied and certainly not universal. Some patients fail to respond to any of them for any length of time. The success of fat grafting in the hand for cosmetic augmentation and in the treatment of wound healing problems of various etiologies raises the question of whether it might be similarly effective in decreasing Raynaud’ symptoms.
In the May 2014 issue of Plastic and Reconstructive Surgery journal, an article addressing this potential treatment appeared entitled ‘Fat Grafting to the Hand in Patients with Raynaud Phenomenon: A Novel Therapeutic Modality’. In thirteen patients (21 hands) with Raynaud phenomenon and Raynaud disease, processed abdominal fat was injected into the dorsum of the hands as well as into the volar webspaces. An average of 30mls of fat was injected per hand. Patients underwent before and after injection laser speckle imaging. The fat injections resulted decreased pain, less cold-related attacks, improved skin texture and healing of ulcerations in most treated patients. Three patients (23%) failed to have any symptom improvement. Laser speckle imaging was inconsistent and showed increased blood flow in less than half of the hands that were tested.
While hand fat injections did not help every patient, enough were improved to indicate that the addition of fat can be added to the list of Raynaud treatments. It is not yet understood how fat may help in this condition. Plausible mechanisms include the addition of soft tissue volume which increases overall hand perfusion, the influence of stem cells on ischemic tissue or some combination to both. Regardless of mechanism, fat is a safe, natural and well recognized procedure with no side effects other than requiring a minor surgical procedure.
Dr. Barry Eppley
Indianapolis, Indiana