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A 42-year-old woman with diabetes
and upper extremity
atherosclerosis developed ischemic ulceration of
the left long finger. Progressive necrosis and ray
amputation resulted in a mid hand wound and partial
necrosis of the ring finger. After a few weeks of
good wound hygiene, silver sulfadiazine, and debridement,
the wounds stabilized, and necrosis and further
ulceration were arrested. Arterial pressure and
circulation were not as bad as first thought, evidenced
by the completely healed central hand. Granulation
tissue attests to active wound healing and a potentially
salvageable ring finger, as long as essential coverage
issues over the skeletal structures can be fulfilled.
The usual flaps from adjacent fingers cannot be
done in this high risk arteriopathic hand.
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After excisional debridement,
specific structures needing coverage were the web
space, the proximal interphalangeal joint, and the
flexor tendons and their sheath. Integra was used
to manage the wound.
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The hand healed with a fully
compliant web space and no contracture. The interphalangeal
joint had a persistent small ulcer, which was closed
with a small secondary flap from the dorsum of the
joint. Joint motion is limited, but the patient
eschewed therapy and is very happy to have a healed
hand without having lost the ring finger.
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Cases Courtesy of:
Marc E. Gottlieb, M.D., Jennifer Furman
Journal of Burns and Wounds, Vol 3, #2
