PMC6968677_01
(a,b) The patient's right index and middle fingers on preoperative evaluation showing fingertip ulceration.
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On physical exam, there were exquisitely tender ulcerations at the tips of the right index and middle fingers, and left middle finger (Figure 1(a,b)).
Hyperplastic Pacinian corpuscles located adjacent to the radial neurovascular bundle of the right index finger.
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Upon elevation of the skin flaps, numerous Pacinian corpuscles were noted amidst the volar subcutaneous tissue adjacent to the neurovascular bundles (Figure 2).
(a,b) Formal sympathectomies were performed on both the radial and ulnar neurovascular bundles with use of the operating microscope.
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Formal sympathectomies, using an adventitial stripping technique, were performed on both the radial and ulnar neurovascular bundles with the use of the operating microscope (Figure 3(a,b)).
(a,b) Evidence of healed digital ulcerations at 3-month follow-up.
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At his 3-month follow-up appointment he was noted to be pain-free and his digital ulcerations were completely healed (Figure 4(a,b)).
Cross-section of Pacinian corpuscle showing multi-lamellated connective tissue capsule at 2x (a), 4x (b), and 20x (c) magnification.
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Tissue samples were sent to pathology for microscopic evaluation where the ultrastructures of the corpuscles were noted to be normal and not concerning for malignancy (Figure 5(a,b)).