This report presents three patients that where failing medical management and where referred for surgical intervention because of infracted or impending infarction of distal pulp skin and severe rest pain despite aggressive medical management. The patients have only been followed for short periods of time but are presented because of the significant early results. The first patient in this study had hyperhidrosis of the palm skin. That finding convinced us to try Botulinum toxin A to ameliorate the sympathetic activity in the palm. Within 24 of injection the patient’s hand stopped sweating, vascular flow dramatically improved and perfusion of the pulp skin resulted in healing minor ulcers and relief of ischemic pain. The results have persisted for four months after administering the toxin. The two other reported patients have been followed for two months following injection and did not have hyper hidrosis but based on the first patient outcome they where also treat with the toxin. They have both responded by increasing flow, decreasing pain, avoiding necrosis in one patient, and secondary healing after removing infracted tissue in a third patient. All 3 patient demonstrated decreased vasopastic attacks and they all reported significantly less rest pain. The sites of injection, doses used and longer term follow up will be reported. This is the first know report of using Botulinum toxin for the management of severe vasospastic disorders.