Upper-extremity digital amputation secondary to non-traumatic ischemia.

Area of Science:

• Medicine
• Surgery
• Vascular Surgery

Background:

• Acute non-traumatic upper-extremity digital ischemia can lead to amputation.
• Septic or non-septic emboli are potential causes of this ischemia.
• Identifying the primary focus of emboli is often challenging.

Purpose of the Study:

• To evaluate factors influencing outcomes in patients with upper-extremity digital amputation due to acute non-traumatic ischemia.
• To determine the impact of delayed diagnosis and unknown embolic sources on prognosis.

Main Methods:

• Retrospective evaluation of nine patients with digital amputations secondary to emboli.
• Analysis of patient history, clinical suspicion of ischemia, and time to hand surgery consultation.
• Assessment of patient health condition and presence of cardiac disease.

Main Results:

• In six of nine patients, the primary embolic focus remained unconfirmed.
• No patient had a history of cardiac disease that could explain the emboli.
• Delayed recognition of ischemia, particularly with unproven embolic sources, correlated with unfavorable prognosis.
• Life-threatening conditions at diagnosis led to attention diversion and delayed ischemia recognition.

Conclusions:

• An unknown or unproven primary focus of emboli, including septic emboli, is a significant factor for poor prognosis in upper-extremity digital ischemia.
• Prompt recognition and early surgical consultation are essential to prevent or minimize digital amputation.
• A high index of suspicion is required for diagnosing upper-extremity digital ischemia, especially when the embolic source is unclear.