Functional Reconstruction of the Hand After Gangrene Affecting All Extremities

Digital gangrene following septic shock is a debilitating condition that leads to multiple shortened digits and marked functional loss. In symmetric peripheral gangrene (SPG), both hands and feet are affected, eliminating standard reconstructive options such as toe transfers. We present a patient with SPG secondary to septic shock, exacerbated by prolonged vasopressor use, resulting in gangrene of all 4 extremities. A staged reconstructive approach was performed for both hands, utilizing on-top plasties, ray amputation, and local flap rearrangement to restore basic hand function. The initial management, reconstructive reasoning, and challenges encountered are described.