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

Jae-Hyuk Shin; Ho-Guen Chang; Cheol-Jung Yang; Jungtae Ahn

doi:10.12671/jkfs.2015.28.4.245

Journal List > J Korean Fract Soc > v.28(4) > 1038039

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Shin, Chang, Yang, and Ahn: Salvage Therapy from Traumatic Ischemic Finger Necrosis via Prostaglandin E1 Assisted Conservative Treatment: A Case Report

Case Report

Journal of the Korean Fracture Society 2015; 28(4): 245-249.

Published online: 19 October 2015

DOI: https://doi.org/10.12671/jkfs.2015.28.4.245

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

Jae-Hyuk Shin, M.D., Ph.D., Ho-Guen Chang, M.D., Ph.D., Cheol-Jung Yang, M.D., Jungtae Ahn, M.D.^*

Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.

^*Department of Orthopaedics and Traumatology, Cheju Halla General Hospital, Jeju, Korea.

Address reprint requests to: Ho-Guen Chang, M.D., Ph.D. Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong 18450, Korea. Tel: 82-31-8086-2891, Fax: 82-31-8086-2438, jshin2100@gmail.com

Received 8 July 2015 Revised 24 August 2015 Accepted 24 August 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Finger, Ischemia, Necrosis, Prostaglandin E1, Salvage therapy

Figures and Tables

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).

Notes

^{Financial support} None.

^{Conflict of interest} None.

References

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.

TOOLS

Similar articles