Churchill Catherine L, Polowczyk James R
Resident, Podiatric Surgical Residency Program, Jersey Shore University Medical Center, Neptune, NJ.
Attending Physician, Department of Podiatric Surgery, Jersey Shore University Medical Center, Neptune, NJ.
J Foot Ankle Surg. 2017 May-Jun;56(3):674-679. doi: 10.1053/j.jfas.2017.01.041.
The development of gangrene after elective digital surgery is a rare complication. We present a case of a patient with normal preoperative vascular examination findings and a history significant for untreated hepatitis C. The patient underwent revisional second toe arthrodesis and plantar plate repair with pin fixation. After surgery, she developed gangrene and ultimately required partial digital amputation. The wound at the amputation site worsened postoperatively, warranting a rheumatologic evaluation that revealed previously undiagnosed cryoglobulinemia. Cryoglobulinemia is defined as the presence of abnormal proteins in the blood that crystallize when cooled. It can cause systemic vasculitis and is often associated with hepatitis C infection. The hyperviscosity of the immunoglobulins and an intravascular inflammatory response can lead to thrombosis and ischemic tissue loss. In the absence of peripheral arterial disease, patients undergoing digital surgery who develop digital infarcts should be screened for cryoglobulinemia as a potential cause for digital necrosis, especially if the patient has a history of hepatitis C. We describe a case of an unusual presentation of gangrene after elective digital surgery and highlight the need for a rheumatologic evaluation in cases in which vasculitis is suspected.
择期手指手术后发生坏疽是一种罕见的并发症。我们报告一例患者，其术前血管检查结果正常，且有丙型肝炎未治疗病史。该患者接受了二次趾关节固定术及跖板修复并使用钢针固定。术后，她发生了坏疽，最终需要进行部分手指截肢。截肢部位的伤口术后恶化，因此进行了风湿科评估，结果显示此前未诊断出的冷球蛋白血症。冷球蛋白血症定义为血液中存在冷却时会结晶的异常蛋白质。它可导致系统性血管炎，且常与丙型肝炎感染相关。免疫球蛋白的高黏滞性和血管内炎症反应可导致血栓形成和缺血性组织损伤。在没有外周动脉疾病的情况下，接受手指手术并发生手指梗死的患者应筛查冷球蛋白血症，以作为手指坏死的潜在原因，尤其是如果患者有丙型肝炎病史。我们描述了一例择期手指手术后坏疽的不寻常表现病例，并强调在怀疑有血管炎的病例中需要进行风湿科评估。
