Post-traumatic Digital Gangrene Associated with Epinephrine Use in Primary Raynaud’s Phenomenon Lesson for the Future

Abstract

BACKGROUND: Following digital surgical procedures, the ensuing post-operative course may becomplicated by the presence of underlying ischaemic or vasospastic process. In the presence of suchconditions, post-operative ischaemic changes may be further exacerbated with the use of localanaesthetics in combination with epinephrine.CASE DETAILS: We report a 21 year-old female who presented with an amputated fifth digit due to arapidly spreading gangrene which started immediately after the surgical repair of a traumatic lacerationwhich was infiltrated with a pre-mixed solution of lignocaine and epinephrine 3 hours earlier. Thepatient’s final diagnosis was epinephrine-associated digital gangrene in the background of primaryRaynaud’s Phenomenon (RP).CONCLUSION: The author reports this case in order to reiterate the importance of thorough clinicalevaluation prior to the use of epinephrine in digital anaesthesia as well as to increase awareness on howprimary RP can be complicated by gangrene.KEYWORDS: Digital gangrene, trauma, epinephrine, Raynaud’s phenomenon