[Gangrene of the fingers caused by accidental intra-arterial injection of diazepam].
METHODS
A 51-year-old woman was accidentally given an intra-arterial injection of 10 mg diazepam to control an acute claustrophobic anxiety attack. She complained of severe knocking pain in the entire left arm during the injection. On the second day the hand and lower arm were red an swollen and she complained of increasingly feeling cold and having paraesthesias. On the fifth day the radial half of the palm as well as the first to third digits showed livid discoloration. In the further course necrotic areas developed in the palmar aspect of the distal phalanx of the thumb and of the index finger proximal to the middle phalanx.


METHODS
Angiography on the tenth day after the injection revealed very poor perfusion of the radial artery as far as the wrist, occlusion of the superficial palmar arterial arch and occlusions of the digital arteries of the five fingers.


METHODS
Infusion of 25,000 IU heparin over 24 h brought no improvement. On the 24th day after the diazepam injection the palmar aspect of the distal phalanx of the thumb and the index finger became necrotic, requiring amputation of the latter and, after removal of necrotic tissue, flap-plasty using subcutaneous soft tissue of the extensor surface of the index finger to cover the defect on the thumb. The patient was without symptoms on discharge and the wounds were healing well.


CONCLUSIONS
Every doctor should be aware of the dangers of accidental intra-arterial injection. The slightest suspicion and symptoms require immediate and adequate treatment to save the limb.
Klinik und Poliklinik für Unfall- und Handchirurgie, Westfälische Wilhelms-Universität Münster.
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A
Joist
C O
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Tibesku
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M
Neuber
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U
Frerichmann
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U
Joosten
D000671:Amputation, Surgical; D000792:Angiography; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery*; D003937:Diagnosis, Differential; D003975:Diazepam / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D005385:Fingers / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005734:Gangrene; D006801:Humans; D007269:Injections, Intra-Arterial / Q000009:adverse effects; D008875:Middle Aged; D009336:Necrosis; D013524:Surgical Flaps
D014151:Anti-Anxiety Agents; D003975:Diazepam
Fingergangrän nach akzidenteller intraarterieller Injektion von Diazepam.