Pressure necrosis of the fingertip during management of hand burn injury: a word of caution.

Dear Editor, Pressure necrosis is an unwarranted, preventable complication and can be influenced by various internal and external factors. We are presenting an unusual case of fingertip pressure necrosis that occurred during the management of a hand burn injury. A 57-year-old, right-handed dominantmale patient presented to the accident and emergency department with a contact burn caused by the coal fireplace at home to the dorsum of his right middle, ring and little finger. The patient is an ex-smoker and is known to have insulin-dependent diabetes causing peripheral diabetic neuropathy. On examination, he had deep dermal burns to the dorsum of the middle finger and a mixed thickness burn to the right ring and little fingers. He had an immediate debridement and excision of burnt skin of the middle and ring fingers and reconstruction with split skin grafts. It was decided to manage the little finger with repeated dressings until the burnt skin fully demarcates. Twoweeks later, the grafts failed and the little finger’s burn did not heal. To cover the unhealed wounds, two random abdominal flaps were raised to reconstruct the little and ring fingers and it was decided to preserve the graft of the middle finger. The hand was dressed with jelonet, packed well with gauze and held in place with adhesive plaster (Figure 1). He was attending the dressing clinic regularly and he was advised to use the right thumb and index fingers to enhance mobilization and to avoid joint stiffness. Twenty days later, he was taken to theatres for the separation of the skin flaps. The flaps were healthy but the graft on the middle finger failed and further grafting was performed. A small area of pressure necrosis on the pulp of his index finger measuring 1× 1 cm was noticed (Figure 2). The pressure necrosis was treated conservatively. Strict advice was given