Abstract
Acute arterial obstruction of the upper limb merely leads to severe ischemic tissue defect. We experienced a case of massive and progressive tissue defect due to acute upper limb ischemia, successfully treated by bypass operation. The patient was a 73 years-old man who had had atrial fibrillation and cerebral infarction. He was found lying down alone at his room and diagnosed cerebral infarction. His left thumb and index finger had massive tissue necrosis. The finger amputation and debridement were performed in nearby hospital. Although skin graft had been performed for the skin defect, the graft became necrosis. Angiography revealed the interruption of left brachial artery. SPP was 42 mmHg at the palm. We diagnosed severe upper limb ischemia due to thrombus derived from atrial fibrillation, combined with tissue necrosis due to compression on his left upper limb. Brachio-ulnar artery bypass and debridement of necrotic tissue were performed at our hospital. After 5 months, left hand showed good granulation and epithelization. We concluded that bypass surgery should be performed for severe upper limb ischemia without missing an opportunity in case of progressive tissue defect.
