Finger Necrosis Research Articles

Single-stage reconstruction of congenital multi-finger syndactyly with contiguous cross-shaped advancement flaps.

The purpose of this paper is to report the techniques and results of contiguous dorsal cross-shaped advancement flaps for reconstruction of the three- or four-finger syndactyly in a single-stage operation for congenital syndactyly. Thirty-five patients with multiple-finger syndactyly for web-space reconstruction using the contiguous dorsal cross-shaped advancement flaps in a single operation were retrospectively studied. The patients were treated between January 2019 and October 2022. There were 20 patients with Poland syndrome, nine with constriction ring sequence, and six with synpolydactyly. One patient had bilateral hands involved. Twenty-three hands had three-finger syndactyly, and 13 hands had four-finger syndactyly. The patients' ages ranged from 5 to 96 months, with an average age of 29.6 months. The contiguous dorsal cross-shaped flaps were advanced to reconstruct both web space and lateral walls of the bases of the conjoined fingers. Withey grading was used for postoperative evaluation of web creep of each reconstructed web. Scar hyperplasia was assessed using the Vancouver Scar Scale (VSS). Visual Analogue Scale (VAS) of 0 to 10 was applied to evaluate the subjective satisfaction of the parents with the overall appearance and function. In all cases the syndactyly was successfully released in a single operation. There were no perioperative complications such as finger necrosis, incision infection, or skin graft failure in this group. During a 12-to-58-month follow-up period, all the reconstructed web spaces exhibited satisfactory appearance, and there was no obvious web creep. The scars on the dorsal side of the hand were acceptable. Revision surgery was not needed in any patients. Web creep averaged 0.45, and the VSS score averaged 1.6. The average VAS score of appearance was 1.2, and that of function was 2.5. Multiple syndactyly release in one stage is feasible and safe. The contiguous cross-shaped flaps can be used to reconstruct two or more web spaces simultaneously after releasing.

The Role of CT Guidance in T2–T3 Sympathetic Block: Overindulgence or Essential Safety Measure?

Pain management is crucial in health care, especially in India where chronic pain affects millions of individuals. This case report discusses a rural woman with left finger gangrene unresponsive to medical management. She was planned for computed tomography (CT)- guided T2–T3 sympathetic block but was deferred due to incidental finding of pericardial effusion. Further evaluation revealed that she had systemic lupus erythematosus (SLE). She was subsequently managed with an ultrasound-guided stellate ganglion block. This case outlines the importance of thorough preprocedural evaluation and highlights the advantages of CT guidance in preventing complications and facilitating proper intervention.

Successful Revision Using Distal Inflow for Dialysis-associated Steal Syndrome with Finger Gangrene

Successful Revision Using Distal Inflow for Dialysis-associated Steal Syndrome with Finger Gangrene

Reevaluating the epinephrine myth: A comprehensive review.

The combination of local anesthetic drugs with epinephrine has conventionally been contraindicated in acral regions due to concerns of potential necrosis caused by compromised blood flow. However, this belief has been challenged since 2001, when studies demonstrated the safety and effectiveness of the combination. This review aims to analyze reported cases of acral area necrosis following the use of local anesthesia with epinephrine since 2001. A thorough search was conducted on PubMed and Google Scholar using specific keywords to identify articles reporting acral area necrosis caused using local anesthesia and epinephrine. Our search yielded eight publications describing a total of 13 cases of ischemic events in acral areas. These cases involved finger necrosis (five cases), scrotal skin necrosis (two cases), and eyelid necrosis (six cases), following the injection of a combination of epinephrine and lignocaine. The majority of affected patients were female who underwent surgical intervention and reconstruction. The use of epinephrine in local anesthesia offers significant advantages and is generally safe for acral areas. However, the risk of necrosis cannot be entirely eliminated, particularly in patients with compromised vascular function. Adhering to proper guidelines and selecting suitable patients can help mitigate the risk. Phentolamine serves as a potential rescue agent if vascular compromise occurs. Precautionary measures must be taken when using this combination in high-risk patients.

An Experimental Phototherapy Device for Studying the Effects of Blue Light on Patients with Raynaud's Phenomenon.

Raynaud's phenomenon (RP) is a condition that causes decreased blood flow to areas perfused by small blood vessels (e.g., fingers, toes). In severe cases, ulceration, gangrene, and loss of fingers may occur. Most treatments focus on inducing vasorelaxation in affected areas by the way of pharmaceuticals. Recently, animal studies have shown that vasorelaxation can be induced by non-coherent blue light (wavelength ~ 430-460nm) through the actions of melanopsin, a photoreceptive opsin protein encoded by the OPN4 gene. To study this effect in humans, a reliable phototherapy device (PTD) is needed. We outline the construction of a PTD to be used in studying blue light effects on Raynaud's patients. Our design addresses user safety, calibration, electromagnetic compatibility/interference (EMC/EMI), and techniques for measuring physiological responses (temperature sensors, laser Doppler flow sensors, infrared thermal imaging of the hands). We tested our device to ensure (1) safe operating conditions, (2) predictable, user-controlled irradiance output levels, (3) an ability for measuring physiological responses, and (4) features necessary to enable a double-blinded crossover study for a clinical trial. We also include in the Methods an approved research protocol utilizing our device that may serve as a starting point for clinical study. We introduced a reliable PTD for studying the effects of blue light therapy for patients suffering from Raynaud's phenomenon and showed that our device is safe and reliable and includes the required measurement vectors for tracking treatment effects throughout the duration of a clinical study.

Buerger's Disease of Hand; my Experience with Phenol Chemical Neurolysis of Stellate Ganglion: Case Series of Six Patients.

Buerger's disease is common in 74.70% of cases in the lower limb but in 20.20% of cases, it is found in the upper limb or hand. The disease usually starts from pain in the finger/thumb or hand and then to more centrally.Patients presented with pain in the hand with gangrene of fingers. Pain aggravated on lifting hand above the shoulder level or above heart level in upright or lying in the bed, respectively. In almost all patients, there was a history of smoking except one and all patients had involvement of digits of the right or left hand. Diagnosis of Buerger's disease was made based on the history of smoking, weak or absent pulse, lack of bleeding, swelling, edema, blackening, stony hard fingers or thumb on clinical examination, and color Doppler study of the limb.In all patients, Stellate ganglion chemical neurolysis with 8% phenol was done at C7-T1 under fluoroscopic and radiocontrast dye (Iohexol 300) guidance.After successful neurolysis patients got excellent pain relief, their wounds started healing, the vascularity of the diseased part increased and the disease stopped progressing. Stellate ganglion chemical neurolysis with phenol in Peripheral vascular disease or Buerger's disease of hand is an effective method to stop the disease procession, promoting wound healing, controlling ischemic pain, and avoiding surgical amputation.

Black necrosis of the glans penis associated with calciphylaxis: A case report.

Calciphylaxis, known as calcific uremic arteriolopathy, is a rare cause of dry gangrene. Despite an increase in the clinical recognition of demographic characteristics and risk factors associated with calciphylaxis, it remains a poorly understood disease with high mortality. We present a 45-year-old man, who was diagnosed with calciphylaxis disease, with a history of diabetes mellitus, end-stage renal disease and cirrhosis with a half-month evolution of painful dry gangrene on his glans penis and scrotum. The patient also presented with gangrene of fingers. The patient and his family opted for palliative care. However, he died eventually. This case contributed to the current understanding of calciphylaxis. Since no standard treatment is available and the prognosis remained poor, early, and accurate diagnosis of calciphylaxis is important. We here report the current case and provide data for the diagnosis and treatment of this kind of disease.

Symmetrical Fingertip Gangrene in a Factory Worker Exposed to Paint Thinner

Symmetrical peripheral gangrene involving the fingertips is a frequent manifestation of atherosclerotic or embolic thrombi. It may indicate an underlying systemic vasculitis or suggest an environmental exposure to freezing temperatures. We present a case of a factory worker who inadvertently got exposed to paint thinner at workplace, leading to gangrenous changes in his exposed fingertips. The clinical examination and investigations could not reveal any inflammatory or hypercoagulable state, and arterial vasospasm was found to be the most possible reason attributable to this event. The patient was managed with antiplatelet drugs and arterial vasodilators. In a case of bilateral symmetrical finger gangrene, physicians must systematically search for a professional or occupational as a putative factor.

The Iatrogenic Injury Potential of Self-adherent, Elastic Bandages in Finger Injuries.

The use of a self-adherent, elastic bandage is a practical way to dress finger injuries. Multiple reports describe iatrogenic injuries from elastic bandages, ranging from skin necrosis to finger gangrene, necessitating amputations. This study investigated whether elastic bandages can compromise digital perfusion by occluding arterial blood flow in healthy volunteers and evaluated the utility of pulse oximetry as a monitoring tool for digital perfusion. A technique for safe bandage application is proposed. A commercially available elastic bandage was wrapped around the index finger of 20 healthy volunteers at varying degrees of stretch. Digital perfusion measurements were carried out using photoelectric pulse transduction, laser Doppler flowmetry, and pulse oximetry. Intracompartmental pressure measurements were recorded using a separate in vitro experimental model. Elastic bandages applied at maximum stretch did not change digital brachial index or pulse oximetry values, suggesting arterial blood flow was preserved distal to the bandage. Intracompartmental pressure measurements at maximum stretch remained below the systolic digital pressure. In contrast, superficial dermal perfusion fell to 32% of normal as measured by laser Doppler flow, at 100% bandage stretch. This study suggests a risk for iatrogenic injury when using elastic bandages for finger dressings. While arterial inflow was never compromised, pressures were high enough to occlude superficial venous outflow, which may begin at 20% bandage stretch. Pulse oximetry failed to detect changes distal to applied dressings, and we do not recommend it to detect digital vascular compromise in this setting.

Treatment of Multiple Finger Laceration Caused by Green Onion Cutting Machines in South Korea.

Background: Finger injuries caused by green onion cutting machines in Korean kitchens have unique characteristics of an incomplete amputation in which multiple parallel soft tissues and blood vessels are injured in the same form. In this study, we aimed to describe unique finger injuries and to report the treatment outcomes and experiences of performing possible soft tissue reconstructions. Methods: This case series study included 65 patients (82 fingers) from December 2011 to December 2015. The mean age was 50.5 years. We retrospectively classified the presence of fractures and the degree of damage in patients. The injured area involvement level was categorised as distal, middle or proximal. The direction was categorised as sagittal, coronal, oblique or transverse. The treatment results were compared according to the amputation direction and injury area. Results: Of the 65 patients, 35 had a partial finger necrosis and needed additional surgeries. Finger reconstructions were performed through stump revision or local or free flap use. The survival rate was significantly lower in patients with fractures. As for the injury area, distal involvement led to 17 out of 57 patients displaying necrosis and all 5 patients showing the same in proximal involvement. Conclusions: Unique finger injuries caused by green onion cutting machines can easily be treated with simple sutures. Then prognosis is affected by the extent of injury and the presence of fractures. Reconstruction is necessary for finger necrosis owing to extensive blood vessel damage and limitations when making this selection. Level of Evidence: Level IV (Therapeutic).

Kinked Innominate Artery – A Rare Cause for Upper Limb Ischemia

Abstract Interventions of the aortic arch can lead to unexpected complication of atheroembolization from the plaques with many cases of CVA following TEVAR being reported in the literature. It is especially seen in old diabetic patients. Embolizations is a known entity in cases of loop Common carotid vessels. The abnormal curvature causes stasis of blood leading onto development of thrombus. Diseases related to Innominate artery are very rare. Kinking of Innominate artery is even rarer abnormality and very few cases only have been reported in the literature. The various clinical scenarios of kinked innominate artery reported are presence of pulsatile mass in the neck, In CXR the kinked artery masquerading as right upper lobe lung mass. Herein we report a case of Right upper limb little finger gangrene following coronary angiogram. On CT Angio evaluation it was found that there was thrombus in distal innominate and subclavian vessels with kinking of Innominate, Left Common carotid and Left Subclavian also. The passage of hardwares across the kinked innominate artery had caused the thrombus formation and subsequent embolization. This is the 1st case in literature to report the kinked innominate artery has caused a procedural complication. We report this case to inform that extreme caution should be undertaken during interventional procedures in cases of abnormal curvatures of great vessels to avoid complication.

Nasolabial and distal limbs dry gangrene in newborn due to hypernatremic dehydration with disseminated intravascular coagulation: a case report

IntroductionGangrene is the death of an organ or tissue due to lack of blood supply or bacterial infection. In neonates, gangrene is usually caused by sepsis, dehydration, maternal diabetes, asphyxia, or congenital anticoagulant deficiency. It commonly occurs in the extremities. Gangrene may lead to death or amputation of the limb. Early diagnosis and prompt management of the underlying cause halts the progression of the disease.Case presentationA 12-day-old neonate presented with a complaint of black discoloration of the nose and feet for 2 days. He was breastfeeding poorly and had signs of dehydration. Upon physical examination, he was tachycardic (pulse rate = 182 beats per minute), tachypneic (respiratory rate = 62 breaths per minute), and hypothermic (temperature = 35.0 oC). He lost 33.3% of his birth weight. He had demarcated cold, dry, and dark discoloration of the entire nose, nasal septum; upper lip; palate; bilateral distal lower limbs; and the left fifth finger. Dorsalis pedis arteries were not palpable on either side. On investigation, the baby had pancytopenia, hypernatremia, elevated creatinine, elevated coagulation profiles, and absent arterial flow in bilateral dorsal pedis arteries. He was treated for hypernatremic dehydration and possible sepsis. He was transfused with whole blood, platelets, and fresh frozen plasma, but finally, the patient passed away on the 7th day of admission.ConclusionThe entire nose, upper lip, soft and hard palate, symmetric lower limb, and fifth finger gangrene due to severe hypernatremic dehydration complicated by disseminated intravascular coagulation may occur in the same patient. To avoid such serious neonatal problems, mothers should be properly educated about optimal breastfeeding techniques and schedule well-child visits 3–5 days after birth.

A Case of Finger Necrosis Caused by Primary Macroglobulinemia with Cold Agglutinin Disease

A Case of Finger Necrosis Caused by Primary Macroglobulinemia with Cold Agglutinin Disease

Clinical Application of Restrictive Brace Combined with Psychological Intervention after Replantation of Severed Fingers in Children.

Objective After replantation of severed fingers in infants, the utility model patent upper limb restrictive brace-assisted bed rest braking, combined with psychological intervention, can alleviate children's anxiety, so as to reduce the occurrence of vascular crisis. Methods The study period was from April 2015 to July 2018. In this paper, 30 children with finger injuries in hand surgery in the CIS electronic medical record system of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital were selected as the research objects. Replantation was performed in 30 infants with severed fingers. Among them, 15 cases were applied with the method of aircraft chest arm gypsum splint combined with sedative drug braking and the utility model patented product upper limb restrictive brace fixation-assisted bed rest braking, and the method of psychological intervention was applied at the same time. Results Among the 15 fingers in the control group, 6 had vascular crisis and 1 in the experimental group. The incidence of vascular crisis in the experimental group was lower, and the difference between the two groups was statistically significant (P < 0.05). The patients were followed up for 9~18 months, with an average of 9.72 ± 1.07 months. In the control group, 15 cases of severed fingers survived, and there were 13 cases of replantation finger necrosis in 2 cases of intractable arterial crisis. In the experimental group, 14 cases of severed fingers survived in 15 cases and there was 1 case of replanted finger necrosis in intractable arterial crisis after operation. There was no significant difference in the survival rate between the two groups (P > 0.05). In addition, the replanted finger function was evaluated. In the control group, 9 cases were excellent, 4 cases were good, and 1 case was fair. In the experimental group, 14 cases were excellent, 1 case was good, and 0 case was fair. The functional evaluation of the experimental group was better than that of the control group, and the difference between the two groups was statistically significant (P < 0.05). Conclusion For infants after replantation of severed fingers, the application of the utility model patented product upper limb restrictive brace can effectively make up for the insufficient fixation of aircraft chest arm gypsum splint, reduce the occurrence of vascular crisis, and assist children in bed. In addition, the application of psychological intervention can reduce children's postoperative crying and is conducive to children's postoperative recovery.

A diabetic patient with finger gangrene

A 72-year-old male with type 2 diabetes and end-stage renal disease (ESRD) receiving hemodialysis (HD) for 10 months presented to hospital with one week of worsening pain, swelling, and bluish-black discoloration in the second and fourth right, and third left fingers. Preceding trauma to the digits had not occurred. Physical examination revealed dry gangrene in the digits (Fig. A), but no necrotic lesions in the lower limbs. An arteriovenous fistula (AVF) was created in his left forearm. Laboratory examinations showed fairly controlled diabetes (HbA1c 7.3%, post-prandial blood glucose 175 mg/dL), leukocytosis, and elevated C-reactive protein.

Digital Necrosis: The Tip of the Iceberg! About 69 Cases

Digital necrosis is a clinical manifestation of a general or locoregional pathology and represents the ultimate stage of distal ischemia (1). It is more likely to be the consequence of a macroangiopathy which can also sometimes be associated with a microangiopathy. The necrosis of fingers and toes may be caused by a great variety of diseases including collagen vascular diseases (systemic scleroderma…), arteriopathies, vasculitis, haemopathies, occupational diseases and many others (2).

A young girl with severe polyarteritis nodosa successfully treated with tocilizumab: a case report

BackgroundChildhood Polyarteritis nodosa (PAN) is a systemic vasculitis with necrotizing inflammation of medium- and small-sized arteries. Disease evolution may be severe and refractory to standard treatment including prednisone, azathioprine and cyclophosphamide.Case presentationWe present the case of a young girl with severe PAN resulting in progressive ischemia and necrosis of fingers and toes. Biological work-up revealed increased acute phase reactants and interleukin-6 levels. She was only partially controlled despite high-dose corticosteroids and cyclophosphamide infusions, and eventually achieved rapid improvement and sustained remission on tocilizumab.Further, we review the current evidence of the interleukin-6-inhibitor tocilizumab for the treatment of PAN.ConclusionTocilizumab may be an efficient therapeutic option in a subset of treatment-refractory children with PAN.

Ultrasound -Guided Stellate Ganglion Block

In patients of systemic lupus erythematosus (SLE) with vasculitis, along with medical management, stellate ganglion block (SGB) is also recommended frequently to improve the vascularity of the upper limb and in some instances prevent the gangrene of fingers. In this article, we described the management of a SLE patient presented with progressive gangrene of the finger. Ultrasound-guided SGB was successfully given in this patient to relieve pain and improve vascularity, which also helped in healing of ischemic ulcer on digits.

Change of the Pattern of the Demographic Characteristics of the Patients with Endocarditis: Clinical Case of Infectious Endocarditis in Man with Injectible Drug Dependence, Complicated with Pneumonia and Peripheral Necroses of Feet, Arms, Nose (Own Clinical Observations and Experience of Education in State and English Language)

Infectious endocarditis is multisystem disease, which is the result of the infection (usually bacterial) of endocardial heart surface. Despite of the latest medical achievements in diagnostics and treatment, infectious endocarditis is still a disease with high mortality rate and severe complications. During last decades in developed countries there are obvious changes of demographic characteristics of the patients with infectious endocarditis, namely increasing of aged patients with degenerative valvular diseases, of patients with anamnesis of invasive manipulations and procedures. Beside with well known risk factors (artificial valves and implanted heart devices), there are increasing roles of injectible drug-dependence, human immunodeficiency virus and wide contact with health protection system as predisposing factors for infectious endocarditis. The article contains literature data of the main populational risk groups of infectious endocarditis. Clinical case of severe (fatal) infectious endocarditis in patient with injectible drug dependence is submitted. Special features of the case are peripheral dry necroses of feet, arms, nose, which are very close to the description of symmetrical peripheral gangrene. This rare disorder was first described by Hutchinson in 1891 in 37-year old man, who had gangrene of fingers, hands and ears after shock. Symmetrical peripheral gangrene can be induced by different infection and non-inflection causes. The majority of these cases are connected to the treatment of cardiogenic shock with disseminated intravascular coagulation. Submitted description of the case of symmetrical peripheral gangrene in patient with infectious endocarditis will be useful for different medical care specialists as a reminder of the necessity of constant monitoring of the skin color of the distal parts of the limbs in severe sick patients.

Ulceration and Necrosis of Fingers and Toes in an ESKD Patient.

Ulceration and Necrosis of Fingers and Toes in an ESKD Patient.