Devastating ischemic dimelic neuropathy after plastic zip tie handcuffs; message for security agencies.

Ischemic monomelic neuropathy (IMN) is an infrequently recognized type of ischemic neuropathy produced by the shunting of blood away from, or the acute non compressive occlusion of, a major proximal limb artery. IMN consists of multiple mononeuropathies with axonal-loss that develop acutely and simultaneously in the distal portion of a limb. Ischemic neuropathies in a single limb are well-known following compression (casts or tourniquet use), proximal vascular procedures like AV fistula formation, thoracic outlet syndrome, trauma, and thromboembolism. We report the first case of ischemic neuropathies of both upper limbs caused by plastic zip ties handcuffs. We call it "Ischemic dimelic neuropathy (IDN)". This case highlights and increases awareness among physicians and security agencies to recognize ischemic dimelic neuropathy (IDN) early, take measures to prevent this rapidly developing neuropathy, and discourage the use of plastic handcuffs for suspects/accused in their arrest process or inside correctional places.