This article is an answer to the Case – Smoker with an Ulcer on the Tip of the Finger
The ulcer had not responded to treatment with prazosin, nifedipine, or topical nitroglycerin. Examination disclosed diminished pedal pulses and poor vascular collateralization of the right hand on Allen’s test.
An angiogram of the right hand demonstrated multiple chronic occlusions of the digital branches that were unresponsive to intraarterial vasodilators, supporting the diagnosis of thromboangiitis obliterans.
After 51 hyperbaric treatments, with concurrent blockade of the right stellate ganglion twice weekly, the size of the ulcer was reduced by approximately 50 percent.
Because healing by second intention could not be achieved over the exposed necrotic bone, primary closure by skin flap was performed in conjunction with postoperative hyperbaric treatments to ensure healing. The patient has not resumed smoking.
