Gangrenous fingers: the tip of the iceberg.

Over a 7-year period 535 patients presented to our Vascular Service with gangrenous digits, of which 35 had a gangrenous finger (6.5%). The aetiology of digital vessel occlusion was embolic in 15 and thrombotic in 20 patients. The patients came from all ethnic groups with a mean age of 45 years. Proximal atherosclerotic disease of the subclavian artery was the predominant source of embolism (60%), although a variety of other lesions were also responsible. In the thrombotic group, ten were due to collagen vascular disorders, eight to thromboangiitis obliterans and two followed thrombogenic rheological disorders. Twenty-nine patients underwent local amputation and six required chemical debridement. In addition reconstructive surgery, usually extrathoracic bypass, was performed in 13 patients and cervical sympathectomy in nine patients. The operative mortality was zero and none required major amputation on follow-up. It was concluded that the gangrenous finger, unlike the gangrenous toe which is often due to atherosclerosis, may reveal a wide variety of disorders demanding aggressive diagnostic evaluation and therapy.