case_images: PMC4102140_01
case_images: (Left) Ischemic finger on presentation showing epidermolysis and a dusky pulp with no capillary return. (Middle) Day 1 after thrombolysis. Finger reperfused, with restoration of pink color and a capillary refill at the pulp level. (Right) Two months postpresentation. The patient had undergone dry necrosis of the pulp at the level of the third phalanx.
case_images: eplasty14e26_fig1.jpg
case_images: PMC4102140_01_eplasty14e26_fig1.jpg
case_images: F1
case_images: At this time, the examination of the ring finger on the right hand revealed no capillary refill and no bleeding upon puncture (Fig 1, left). Thirty hours after the initiation of thrombolysis, a repeat angiography confirmed almost complete reperfusion of the digital arteries at the distal interphalangeal joint that correlated with the clinical appearance of the digit (Fig 1, middle).
case_images: Hand arteriography of the patient's right ring finger showing bilateral occlusion (arrow) of digital arteries at the level of the second phalanx (left) with acute angles suggesting a thrombotic cause of ischemia. Resolution of previously seen thrombus and distal reperfusion following 24 hours of thrombolytic therapy (right).
case_images: eplasty14e26_fig2.jpg
case_images: PMC4102140_01_eplasty14e26_fig2.jpg
case_images: F2
case_images: The inflammatory reaction secondary to ischemia can be visualized through the hyperemic appearance of the vessels distally, as opposed to the adjacent fingers (Fig 2), which also indicates an occlusive disorder rather than vasospasm.