RESUMEN
The treatment of digital ischemia remains difficult. Sildenafil (Viagra, Pfizer UK), a selective phosphodiesterase inhibitor, increases blood flow and is currently marketed for the treatment of erectile dysfunction. A case of a 57-year-old man with progressive episodic ischemia and pain of the fingertips resulting in finger tip ulceration is presented. After failure of medical and surgical management, a trial of oral sildenafil resulted in marked symptomatic improvement of his bilateral digital ischemia. Review of the literature shows that, particularly in patients with an underlying disease such as sclero-derma with a vasospastic component, a marked improvement in digital blood flow may be observed with sildenafil use. Overall, based on a number of case reports and preliminary animal studies in the literature, sildenafil appears to have a growing significance in the treatment of hand ischemia. Similarly, there is evidence that phosphodiesterase 5 inhibitors may be used as an adjunct to improving skin flap survival.
RESUMEN
Since the autumn of 2001, a multidisciplinary plastic surgery (PS) and physical medicine and rehabilitation (PMR) outpatient amputee clinic has been in place at St Joseph's Health Centre/Parkwood Hospital in London, Ontario. To date, more than 140 new patients have been seen in combined consultations. The present paper reviews the demographics, interventions and outcomes of the patients seen between 2001 and 2005. The majority of primary PMR patients had problems that prevented optimal use of their lower extremity prostheses. These problems included nonhealing pressure ulcers, infections, painful neuromas, amputation stump shape abnormalities and fixed joint contractures. Most patients had surgical intervention. In terms of overall clinical success, 53% of the PMR patients and 77% of the PS patients had their problems resolved. The multidisciplinary collaboration in the PS/PMR outpatient amputee clinic provides a unique service that benefits upper and lower extremity amputees.