{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T19:01:01Z","timestamp":1777662061331,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T00:00:00Z","timestamp":1645401600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hand (New York, N,Y.)"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>Vasopressor-induced ischemia of the hand, while relatively rare, is a severe complication in critically ill intensive care unit (ICU) patients requiring high concentrations of sympathomimetic pressors and often results in digit necrosis and amputation. Currently, there are no widely accepted approaches for treating this cause of peripheral digital ischemia. Case reports have demonstrated that reducing the concentration of vasopressors that patients are given may reverse the progression of ischemic events prior to necrosis. While this approach is at odds with the principle of \u201clife over limb,\u201d it demonstrates that digit necrosis can be reversed, resulting in improved outcomes. Here, we present a therapeutic strategy for treating digital limb ischemia in the septic ICU patient without the need to lower systemic vasopressor dose by using locally injected botulinum toxin A into ischemic hands.<\/jats:p>","DOI":"10.1177\/15589447221075666","type":"journal-article","created":{"date-parts":[[2022,2,22]],"date-time":"2022-02-22T00:14:26Z","timestamp":1645488866000},"page":"NP6-NP9","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Botulinum Toxin A for the Treatment of Sympathomimetic Pressor-Induced Digital Hand Ischemia in the Critically Ill Intensive Care Unit Patient"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2687-1173","authenticated-orcid":false,"given":"Henning","family":"De May","sequence":"first","affiliation":[{"name":"The University of New Mexico, Albuquerque, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avra S.","family":"Laarakker","sequence":"additional","affiliation":[{"name":"The University of New Mexico, Albuquerque, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Borah","sequence":"additional","affiliation":[{"name":"The University of New Mexico, Albuquerque, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,2,21]]},"reference":[{"key":"bibr1-15589447221075666","doi-asserted-by":"publisher","DOI":"10.3171\/2018.11.FOCUS18514."},{"key":"bibr2-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027953."},{"key":"bibr3-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1002\/nau.21102."},{"key":"bibr4-15589447221075666","doi-asserted-by":"publisher","DOI":"10.3390\/toxins5020249."},{"key":"bibr5-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006499.pub4."},{"key":"bibr6-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1046\/j.1524-4725.2003.29124.x."},{"key":"bibr7-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2020.07.009."},{"key":"bibr8-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2362.2004.01324.x."},{"key":"bibr9-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1016\/j.hcl.2014.09.003."},{"key":"bibr10-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181a80576."},{"key":"bibr11-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000244860.00674.57."},{"key":"bibr12-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2012.01.021."},{"key":"bibr13-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006379."},{"key":"bibr14-15589447221075666","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003582."}],"container-title":["HAND"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15589447221075666","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15589447221075666","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15589447221075666","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:28:01Z","timestamp":1777447681000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15589447221075666"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,21]]},"references-count":14,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1177\/15589447221075666"],"URL":"https:\/\/doi.org\/10.1177\/15589447221075666","relation":{},"ISSN":["1558-9447","1558-9455"],"issn-type":[{"value":"1558-9447","type":"print"},{"value":"1558-9455","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,21]]}}}