Surgical treatment options for subacute ischemia of the hand: case report and literature review.
OBJECTIVE
The most effective surgical approach to the treatment of digital ischemia has not yet been established. The purpose of this study is to review currently accepted options for revascularization in acute and chronic settings of digital ischemia, and to augment this discussion by describing the approach of our surgical team in a unique case of subacute ischemia.


METHODS
To restore blood flow to a patient's ischemic hand, we performed a microvascular reconstruction, using a reverse interpositional vein graft with 3 anastomoses: the ulnar artery was used for inflow and the superficial palmar arch and the common digital artery were used for outflow.


RESULTS
The patient experienced immediate postoperative pain relief. Blood flow was restored, which prevented digital amputation. The graft remained patent at 18 months' follow-up and the patient exhibited normal motor and sensory function.


CONCLUSIONS
Surgical reconstruction of the hand is a viable treatment option for carefully selected patients presenting with subacute digital ischemia. Other medical and surgical techniques have been described in the recent literature, but further study is needed to determine the long-term success of newer microsurgical interventions.
Dunn
Ashley A
AA
Department of Surgery, University of California San Francisco, USA. dunnaa@sfghsurg.ucsf.edu
Belek
Kyle A
KA
Devcic
Zlatko
Z
Rathnayake
Samira
S
Kuo
Jennifer H
JH
Kuri
Mauricio
M
Chang
David S
DS
Hansen
Scott L
SL
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