| Hand ischemia in renal failure can be exacerbated by vascular steal effect distal to a dialysis fistula. In this patient, a trivial finger trauma led to a non healing wound which progressed to osteomyelitis deep to the wound. Infected open wounds involving the hands of dialysis patients usually require excision - which often means amputation - to control infection. Amputation is a reasonable primary treatment for this problem when the situation is complicated by diabetes, vascular steal, or transplant related immunosuppression. |
| Click on each image for a larger picture |
| Dialysis fistula. |
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| The chronic finger wound, months after a simple skin laceration. Osteomyelitis was evident deep to the wound. |
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| Radiographs taken shortly after the initial injury (top) compared to those shortly before surgery (bottom) show osteolysis consistent with osteomyelitis: |
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| Surgical incision: |
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| Ray resection was performed using an esmarch bandage for a tourniquet distal to the fistula loop. Alternatively, the procedure could have been performed without tourniquet using elevation and cautery. Some surgeons also use local infiltration of anesthetic / epinephrine solution in this situation as an alternative to use of the tourniquet: |
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| Specimen: |
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| Late result. The amputation healed without incident. |
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