PMC9709858_01
Clinical Progress Photographs during the initial stages of the infection following the wound. Photograph documenting self-inflicted bite wound in the tip of the left third digit (A). Photograph documenting necrosis of the third digit extending to the distal interphalangeal joint and swelling secondary to an abscess in the flexor tendon sheath as well as indications of heat and redness (B).
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The Orthopedics service was contacted to evaluate swelling, heat, and redness of her left hand due to a bite wound at the tip of her left middle finger that was self-inflicted during an episode of dementia. (Figure 1). Vancomycin infusion (trough value, 15-20 mug/mL) was initiated to treat the MRSA infection, together with wound debridement and a partial amputation at the distal interphalangeal joint. (Figure 1).
Radiographs and Computed Tomography of Lungs During COVID-19 Infection. Anteroposterior chest radiograph documenting pneumonia associated with SARS-CoV-2 infection (A). An axial CT scan revealed bilateral pleural effusions (B). A coronal CT scan revealed bilateral lung involvement and ground-glass opacities typically observed in patients diagnosed with COVID-19 (C).
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Results of a chest radiograph and CT scan confirmed this diagnosis and revealed consolidation of the lungs as well as bilateral pleural effusions. (Figure 2).
Pre-operative anteroposterior radiographic image of the left hand. As shown in the image, the patient developed osteomyelitis through the basal phalanx and metaphysis.
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While undergoing treatment for acute life-threatening events, the infection progressed to include the phalanges of the left middle finger, with bone necrosis visible on radiography. (Figure 3).
Photographs documenting the progression of the later stage of the infection over four weeks. Shown are photographs documenting the progression from cellulitis, to purulent tenosynovitis, necrotizing fasciitis, and osteomyelitis. Within one month, the infection progressed from cellulitis (A) to necrosis of the entire finger, with the infection invading the musculature (B). Two weeks after the finger had fully necrosed (C), the infection had extended up to the radiocarpal joint (D).
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The infection progressed to include necrosis of the entire third digit as well as the skin, fascia, and musculature up to the radio-carpal joint with signs of progressive invasion into the forearm (Figure 4).
Perioperative photograph of Arterial calcification and tortuosity. Photograph during amputation surgery documenting heavy calcification and tortuous arteries with the possibility of occlusions in regions that were both proximal and distal to the dialysis shunt. Left, proximal to the torso; right, distal to the torso.
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The procedure revealed heavy calcification of the arteries of her left forearm with tortuosity and possible occlusions both proximal and distal to the shunt (Figure 5).
Radiograph of the left arm after amputation of the distal forearm. Amputation at the distal third of the forearm proximal to the dialysis shunt.
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Adequate skin flap coverage was achieved and the stump was closed; a follow-up radiographic study revealed no complications (Figure 6).