Late results of palmar arch bypass in the treatment of digital trophic disorders.

This study reports the late results of eight palmar bypass procedures performed between 1983 and 1988 in eight men patients with a mean age of 43 years old, who presented with unilateral digital trophic disorders. The origin of the arterial lesions was post-traumatic in four cases, embolic in three cases, and aneurysmal in one. The procedures performed included four radiopalmar bypasses, two ulnar-palmar bypasses, one distal radial bypass and one palmopalmar bypass. In all cases, the replacement conduit used was the superficial radial vein retrieved from the wrist. There were no complications observed in this short series. All fingers healed within three weeks' time after excision of necrotic lesions. During a mean follow-up of 66 months, two bypasses became thrombosed, leading to amputation of the distal phalanx of a thumb in one patient while the remaining six bypasses remained patent, three of them for more than seven years. In the presence of trophic changes of the fingers, palmar arch bypasses, whenever feasible, are more effective at long-term and less aggressive than the usually proposed thoracic sympathectomy.