Poor perfusion needs an explanation beyond the word spasm.

In this episode of Plastics in Practice, we review how to distinguish reversible narrowing from structural and mechanical problems, recognize threatened perfusion, and match treatment to the cause.

Key takeaways:

• Raynaud attacks do not always show the complete white-blue-red sequence; interpret the history, examination and nailfold findings together.

• Persistent pain, cold pallor, new sensory loss or tissue injury requires urgent assessment for threatened perfusion.

• Consider proximal arterial disease, emboli and trauma-related ulnar injury rather than attributing every ischemic digit to spasm.

• For systemic sclerosis-associated Raynaud, calcium channel blockers are first-line; consider PDE5 inhibitors and specialist IV iloprost for appropriate severe or refractory disease.

• Do not combine nitrates, including topical nitrate, with PDE5 inhibitors because of serious hypotension risk.

• Botulinum toxin has negative randomized trial results for routine SSc-Raynaud treatment; selected severe or refractory ulcer use and sympathectomy need specialist judgment and clear discussion of uncertainty.

• In microsurgical compromise, inspect inflow, outflow and the whole pedicle; supportive measures must not delay correction of a mechanical problem.

This content is for educational purposes only and is not medical advice.

The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience.

YouTube Short: https://www.youtube.com/shorts/mKttuP9TwF4

YouTube explainer: https://www.youtube.com/watch?v=1JRVgx-zJC4

Apple: https://podcasts.apple.com/us/podcast/management-of-vasoconstriction-look-beyond-spasm/id1835564216?i=1000795187132

Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/2e14ba0e-7529-4f03-bba5-8378691e40e6/plastics-in-practice-resident-review-management-of-vasoconstriction-look-beyond-spasm

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Free study guide: https://docs.google.com/document/d/1uplJBPSlofHyyXkVnoOWoNkVlHhqpMp6/edit

#RaynaudPhenomenon #DigitalIschemia #Microsurgery #HandSurgery #PlasticsInPractice

References:

1. Maverakis et al. International consensus criteria for the diagnosis of Raynaud’s phenomenon. https://pmc.ncbi.nlm.nih.gov/articles/PMC4018202/

2. EULAR recommendations for the treatment of systemic sclerosis: 2023 update. https://ard.bmj.com/content/early/2024/10/17/ard-2024-226430

3. British Society for Rheumatology guideline for management of systemic sclerosis, 2024. https://academic.oup.com/rheumatology/article/63/11/2956/7750184

4. Senet et al. Botulinum toxin versus placebo for SSc-associated Raynaud phenomenon. https://pubmed.ncbi.nlm.nih.gov/36066501/

5. World Scleroderma Foundation recommendations for local management of digital ulcers, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12084219/