Digit Necrosis After Hand Surgery in Pregnancy: A Case Report

Abstract

Digital blocks are routinely used for excision of lesions. We describe a unique presentation of digit necrosis after excisional biopsy with digital block and finger tourniquet in a pregnant patient with a history of ulcerative colitis. The patient had a history of a long-standing painful dorsal PIP joint mass and was scheduled for excision under local anaesthetic. On the day of the procedure, she disclosed that she was pregnant in the second trimester. After extensive discussion of risks and benefits between the patient and the surgeon, the decision was made to proceed with an excisional biopsy of the lesion because of its impact on her quality of life. Twelve hours after the procedure, she presented to the emergency department with blistering and severe pain to the digit. Doppler ultrasound showed flow through both digital arteries and the digit appeared viable. Over the coming days her pain continued to worsen and on post-operative day 3, she was admitted to hospital for attempted salvage of the digit using conservative methods. Her digit went on to demarcate at the level of the middle phalanx. Five weeks after her initial procedure, the patient underwent partial amputation of the small finger at the level of the DIP joint and 2-stage groin flap for soft tissue coverage. We discuss the effects of pregnancy and ulcerative colitis on thromboembolic events, and review the literature on digital blocks, digital tourniquet use and management of early digit necrosis. This case highlights the importance of delaying elective hand procedures in pregnant patients, especially if they have additional comorbidities such as pro-thrombotic diseases like inflammatory bowel disease.