Journal of Hand Surgery - June 2022 - S498

S498
Journal of Hand Surgery (Eur) 47(Supplement 1)
for treatment on basal thumb arthritis. The aim of
this study is to evaluate results of injection of autologous
fat micro-graft in treatment of first stages of
basal thumb arthritis after arthroscopic evaluation of
cartilage degeneration.
Methods: Authors performed injection on 55 symptomatic
joints stage 1,2,3 of Eaton classification of
basal thumb arthritis. After arthroscopic evaluation
and staging of cartilage damage adipose tissue was
harvested from abdominal region, emulsioned and
injected into the joint without any physical or
enzymatic manipulation under local anesthesia.
Outerbridge arthroscopic and Eaton radiological
classifications were compared and Pain, Pinch
strength, Kapndji score and DASH score were evaluated
pre-operatively and after 1,3,6 and 12 months.
Results: Arthroscopic inspection showed a
Outerbridge stage 4 in many cases of Eaton 2 and 3
stages. There was a significative improvement of
clinical conditions till 6 months with average reduction
of pain from 7,8 to 4,4, improving of pinch
strength from 3,09 to 3,92 and a reduction of DASH
score from 45,6 to 29,6. Results were stable from 6
to 12 months. Best results were identified in Eaton
stage 1 or 2 without severe articular degenerative
changes. Worst results were shown in presence of
Outerbridge stage 4. In 4 cases indication for secondary
open surgery was given at 12 months.
Discussion: Autologous fat graft in thumb carpometacarpal
joint can be effective as in other districts and
can reduce symptoms significantly. It seems to give
better medium-term results in presence of minor
cartilage damages and results can be considered
stable from 6 to 12 months. Role of fat tissue is to
work as shock absorber in first weeks and after to
reduce inflammation of the joint and synovial tissue.
Conclusions: intraarticular autologous fat transplantation
is a promising alternative mini-invasive
treatment of first stages of carpometacarpal joint
osteoarthritis of the thumb.
A-2375 TOxin for Treating Raynaud's Conditions in
Hands (The TORCH Study): A Systematic Review
Ellen Geary1,2, Jake McDonnell1, Kealan Blake1 and
Roisin Dolan1,2
1Department ofPlastic ampersand Reconstructive Surgery,
St Vincent's University Hospital, Dublin, Ireland
2UCD School of Medicine ampersand Medical Science,
University College Dublin, Ireland
Introduction: Raynaud's phenomenon (RP) is a painful
and debilitating condition which affects 3-5% of
the general population. RP has a profound negative
impact on patient quality of life with symptomatology
ranging from intrusive, but benign episodic vasospasm
to progressive obliterative microangiopathy,
in which severe digital ischaemia can threaten
tissue viability. Despite this heavy disease burden,
symptom control and prevention of disease progression
largely rely on pharmacological treatments
which have a significant side effect profile. Several
research groups have reported functional improvements
in pain reduction, RP symptom severity, frequency
of attacks and timely healing of chronic
ulcers following subcutaneous botulinum toxin A
(BTX-A) injections targeting the neurovascular bundles
in the treatment of RP affecting the hands. Aims
The aims of this systematic review are to qualitatively
synthesise the available literature to assess if
BTX-A can prove an effective management strategy
for primary and secondary Raynaud's disease. Our
secondary aim is to provide evidence for the design
of a randomised control trial for using BXT-A in
Raynaud's disease.
Methods: Search strategy and study selection Two
independent reviewers (E.G and J.M) performed a literature
search per PRISMA guidelines and reviewed
the search results, with a senior author (R.D) arbitrating
in the event of a disagreement.1 A comprehensive
search was performed for eligible articles
using the Medline/PubMed database and Cochrane
Collaboration to include studies up to, and including
September 22nd 2021. Search terms included
" Botulinum Toxin-A " þ " Raynaud's " þ/ (i) " primary "
(ii) " secondary " (iii) " disease " (iv) " phenomenon/syndrome "
(v) " treatment " (vi) " management " Eligibility
criteria The inclusion criteria were (1) articles concerning
clinical studies (2) concerning botulinum
toxin-A (3) pertaining to primary or secondary
Raynaud's disease. Exclusion criteria included (1)
case reports (2) reviews (3) abstracts only available
(4) pathology other than Raynaud's (5) botulinum
toxin other than toxin-A (5) paediatric cohorts. Data
extraction and outcomes analysed Outcomes analysed
were primary outcomes of each respective study;
including visual analogue scale (VAS) score, healing
of digital ulcers, number of exacerbated episodes, disabilities
of the arm, shoulder and hand (DASH) scores,
temperature of digits and arterial flow velocity All relevant
information was collected by two independent
reviewers.
Results: The initial literature search produced 287
studies. 39 articles remained for full-text review. A
further 21 articles were excluded with reason. Thus,
18 studies were included for systematic review. In
total, there were 419 patients. The mean time of outcome
assessment was defined in 18 studies, with a
range from 0 to 93 months. Follow-up ranged from 4
weeks 4 months. Nine studies allowed
Journal of Hand Surgery - June 2022

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