case_images: PMC3350209_01
case_images: Clinical findings after admission of the patient, 3 days after the injection.
case_images: CRIM.SURGERY2011-347523.001.jpg
case_images: PMC3350209_01_CRIM.SURGERY2011-347523.001.jpg
case_images: fig1
case_images: After the last injection, she immediately developed progressing, cyanosis and hypaesthesia pain in her hand (Figure 1).
case_images: Digital angiography showing complete blockage of perfusion to the 4th and 5th digits.
case_images: CRIM.SURGERY2011-347523.002.jpg
case_images: PMC3350209_01_CRIM.SURGERY2011-347523.002.jpg
case_images: fig2
case_images: After immediate admission digital angiography showed a complete blockage of perfusion to her 4th and 5th left fingers (Figure 2). Histological workup of the amputated tissue showed necrotic soft tissue and bone, a mildly active osteomyelitis, and small vessel thrombosis.  Figure 5 shows the result 2 weeks postoperatively.
case_images: Demarcated necrosis of the 4th and 5th fingers after 5 weeks.
case_images: CRIM.SURGERY2011-347523.003.jpg
case_images: PMC3350209_01_CRIM.SURGERY2011-347523.003.jpg
case_images: fig3
case_images: The patient was followed up as an outpatient for a total of 5 weeks during which time the acral areas of the digits progressed into dry necrosis (Figure 3).
case_images: Intraoperative view of the amputated 5th finger showing a thrombosed digital artery (circle) with the visible thrombus at the dissected end (arrow).
case_images: CRIM.SURGERY2011-347523.004.jpg
case_images: PMC3350209_01_CRIM.SURGERY2011-347523.004.jpg
case_images: fig4
case_images: With no further treatment option left, the 4th digit was amputated at the distal middle phalanx and the 5th digit was exarticulated in the distal interphalangeal joint.  Figure 4 shows the intraoperative view of a thrombosed digital artery in the 5th digit.
case_images: Amputated fingers after suture removal 2 weeks postoperatively.
case_images: CRIM.SURGERY2011-347523.005.jpg
case_images: PMC3350209_01_CRIM.SURGERY2011-347523.005.jpg
case_images: fig5
case_images: Histological workup of the amputated tissue showed necrotic soft tissue and bone, a mildly active osteomyelitis, and small vessel thrombosis.  Figure 5 shows the result 2 weeks postoperatively.