| Patients requiring long term dialysis for renal failure acquire several problems predisposing to serious hand infection: immune deficiency, calcific vasculitis and upper extremity vascular access procedures, which may reduce distal perfusion. Options for treatment are limited by the presence of regional vascular disease, as in this patient. |
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| Appearance of the wrist and thumb after multiple debridements for progressive infected wound necrosis following failed radiocephalic shunt construction. The radial artery has been ligated. |
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| By this point, the patient has undergone proximal row carpectomy for control of infection involving the scaphoid and lunate. The capitate is visible in the depths of the wound: |
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| Further debridement required decortication of the thumb metacarpal (see below). This defect was covered by the abductor pollicis brevis muscle, mobilized distally and rotated to the dorsum of the thumb metacarpal: |
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| This allowed full closure with skin graft, which healed uneventfully. |
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| Final result. |
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| Postop. |
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