Radial Periosteal Distraction as a Novel Intervention for Raynaud Syndrome with Gangrene: A Case Report

BACKGROUND Raynaud syndrome, also known as Raynaud phenomenon, is characterized by vasospasm of small blood vessels supplying the digits and is usually reversible but can rarely result in severe and irreversible ischemia. Periosteal distraction osteogenesis is a technique that creates a space between the periosteum and the bone surface to stimulate the formation of new bone. This report describes a 67-year-old woman with a 10-year history of Raynaud syndrome presenting with ischemia and gangrene of the right index and middle fingers managed with radial periosteal distraction osteogenesis. CASE REPORT Ten years earlier, the patient received a diagnosis of Raynaud syndrome and had been taking nifedipine sustained-release tablets orally for symptom control ever since. Two weeks before presentation, she successfully recovered from septic shock through the rescue of the Intensive Care Unit. One week before presentation, the patient experienced an aggravation of pain in both fingers. Her distal ends of the right index and middle fingers became darker. After performing the relevant examinations, she received a diagnosis of Raynaud syndrome (bilateral) and gangrene of the right finger. Following the exclusion of surgical contraindications, radial periosteal distraction was performed. The periosteum was continuously distracted after the operation. During follow-up, the patient's gangrene gradually progressively healed, and the pain in both hands markedly diminished. CONCLUSIONS This report supports recent studies that have shown the potential for periosteal distraction osteogenesis in the management of cases of severe and irreversible Raynaud disease of the digits.