J Korean Fract Soc.  2015 Oct;28(4):245-249. 10.12671/jkfs.2015.28.4.245.

Salvage Therapy from Traumatic Ischemic Finger Necrosis via Prostaglandin E1 Assisted Conservative Treatment: A Case Report

• Shin JH
• Chang HG
• Yang CJ
• Ahn J

• KMID: 2070351
• DOI: http://doi.org/10.12671/jkfs.2015.28.4.245

Abstract

Prostaglandin E1 (PGE-1) is a potent vasodilator, which also inhibits platelet aggregation, affects the blood flow viscosity, and fibrinolysis. The compound also excerts anti-inflammatory effects by inhibiting the monocyte and neutrophil function. PGE-1 has been widely administered following microvascular flap surgery, along with perioperative antithrombotic agents such as low molecular weight heparin or aspirin, showing excellent results. We report a case showing successful salvage recovery from post-traumatic ischemic necrosis of the finger via PGE-1 assisted conservative treatment.

Keyword

Finger; Ischemia; Necrosis; Prostaglandin E1; Salvage therapy

MeSH Terms

Alprostadil*
Aspirin
Fibrinolysis
Fibrinolytic Agents
Fingers*
Heparin, Low-Molecular-Weight
Ischemia
Monocytes
Necrosis*
Neutrophils
Platelet Aggregation
Salvage Therapy*
Viscosity
Alprostadil
Aspirin
Fibrinolytic Agents
Heparin, Low-Molecular-Weight

Figure

• 

  Fig. 1 Initial crushing injury to the index finger. Circulation and sensation were negative at the distal phalangeal part of the injured finger. (A, B) Preoperative image. (C) Intraoperative image.

• 

  Fig. 2 At postoperative two weeks, the index finger showed gangrenous necrosis distally from the proximal interphalangeal joint level. During the follow-up period with prostaglandin E1 assisted conservative treatment at postoperative 7 weeks, at 8 weeks, and at 11 weeks, the wound healing proceeded, and the necrotic tissue decreased. At postoperative 14 weeks, the Salvage-therapy reconstruction was complete. (A) 2 weeks, (B) 7 weeks, (C) 8 weeks, (D) 11 weeks, and (E) 14 weeks, postoperatively.

• 

  Fig. 3 At postoperative 4 months, the finger was Salvage-reconstructed. Pulp hypotrophy was noted but the partially maintained active range of motion enabled active cupholding (see the main text).

Reference

1. Brent B. Replantation of amputated distal phalangeal parts of fingers without vascular anastomoses, using subcutaneous pockets. Plast Reconstr Surg. 1979; 63:1–8.

2. Lee JY, Teoh LC, Seah VW. Extending the reach of the heterodigital arterialized flap by cross-finger transfer. Plast Reconstr Surg. 2006; 117:2320–2328.

3. Rodríguez Vegas JM, Ruiz Alonso ME, Terán Saavedra PP. PGE-1 in replantation and free tissue transfer: early preliminary experience. Microsurgery. 2007; 27:395–397.

4. Matsudaira K, Seichi A, Kunogi J, et al. The efficacy of prostaglandin E1 derivative in patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 2009; 34:115–120.

5. Levy JM, Joseph RB, Bodell LS, Nykamp PW, Hessel SJ. Prostaglandin E1 in hand angiography. AJR Am J Roentgenol. 1983; 141:1043–1046.

6. Weiner R, Kaley G. Influence of prostaglandin E1 on the terminal vascular bed. Am J Physiol. 1969; 217:563–566.

7. Rowlands TE, Gough MJ, Homer-Vanniasinkam S. Do prostaglandins have a salutary role in skeletal muscle ischaemia-reperfusion injury? Eur J Vasc Endovasc Surg. 1999; 18:439–444.

8. Campion T, Lynch TG, Kerr JC, Hobson RW 2nd. Effects of prostacyclin injections and infusions on canine femoral hemodynamics. J Vasc Surg. 1986; 3:540–544.

9. Iversen VV, Reed RK. PGE1 induced transcapillary transport of 51Cr-EDTA in rat skin measured by microdialysis. Acta Physiol Scand. 2002; 176:269–274.

10. Cavadas PC. Supramicrosurgical ear replantation: case report. J Reconstr Microsurg. 2002; 18:393–395.