Salvage of an Ischemic Toe with Piracetam (original) (raw)

2005, Plastic and Reconstructive Surgery

Letters to the Editor and Viewpoints are welcome. Letters to the Editor discuss material recently published in the Journal. Letters will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. Viewpoints pertain to issues of general interest, even if they are not related to items previously published (such as unique techniques, brief technology updates, technical notes, and so on). Please note the following criteria for Letters and Viewpoints: • Text-maximum of 500 words (not including references) • References-maximum of five • Authors-no more than five • Figures/Tables-no more than two figures and/or one table Authors will be listed in the order in which they appear in the submission. Letters and Viewpoints should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/ prs/. We strongly encourage authors to submit figures in color. We reserve the right to edit letters and viewpoints to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a letter and/or viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium. The views, opinions, and conclusions expressed in the letters to the Editor and viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.tk;2 LETTERS MANAGEMENT OF ACUTE MIGRAINE HEADACHE WITH LIDOCAINE Sir: The incidental discovery that injection of botulinum toxin is beneficial for treating headaches in some individuals 1,2 stimulated Bahman Guyuron and his colleagues to consider the possibility that resection of the corrugator supercilii muscle is beneficial in the treatment of migraine headache. 3 In Guyuron et al.'s report, 4 migraine headaches improved almost 80 percent. Is it possible that nerve stimulation plays a role in this pathology? With this in mind, I think that if I anesthetize this "trigger point" I may improve the migraine headache. In my hospital where I receive patients with acute migraine headache, I ask patients to rate the intensity of their pain on a scale from 1 to 10 (1, without pain; 10, maximum pain). I then infiltrate 3 cc of lidocaine 2% with epinephrine in the supraciliary zone (trigger zone) in the subcutaneous plane. This improves the pain in minutes. I then ask patients to rate their pain again on a scale of 1 to 10 in 5-minute intervals. When the improvement is palpable, I send the patient home. I invite the medical community to probe this "serendipity" and to conduct new studies with more scientific facts.