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Surgery on extremities with reflex sympathetic dystrophy

P H Veldman1, R J Goris

  • 1Department of Surgery, University Hospital Nijmegen.

Der Unfallchirurg
|January 1, 1995
PubMed
Summary
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Surgery on limbs with reflex sympathetic dystrophy (RSD) is often avoided. However, this study found that operating on RSD-affected extremities resulted in only a 13% recurrence rate, suggesting it is not as dangerous as commonly believed.

Area of Science:

  • Orthopedics
  • Pain Management
  • Neurosurgery

Background:

  • Reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome, often leads to avoidance of surgical intervention on affected extremities due to fears of recurrence or exacerbation.
  • Limited data exists regarding the safety and outcomes of surgical procedures in patients with pre-existing RSD.

Purpose of the Study:

  • To evaluate the safety and outcomes of surgical procedures performed on extremities affected by reflex sympathetic dystrophy (RSD).
  • To determine the recurrence rate of RSD following surgery in affected limbs.

Main Methods:

  • Analysis of 47 patients who underwent surgery on RSD-affected limbs for various indications.
  • Preoperative optimization included delaying surgery until symptoms decreased, optimizing limb perfusion, avoiding tourniquet hemostasis, and administering perioperative mannitol infusions.

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Main Results:

  • Recurrence of RSD was observed in 6 out of 47 patients (13%).
  • The recurrence was mild and temporary in 5 patients, with one patient experiencing a serious and permanent recurrence.

Conclusions:

  • Surgical intervention on extremities affected by reflex sympathetic dystrophy (RSD) carries a manageable risk of recurrence.
  • The findings challenge the widespread belief that surgery on RSD-affected limbs is excessively dangerous, though awareness of potential recurrence is crucial.