Transcutaneous oxygen pressure-guided prophylactic fasciotomy and negative pressure wound therapy for contrast extravasation injury of the hand: A case report.

Abstract

Rationale: Contrast medium extravasation injury is a rare but potentially limb-threatening complication of intravenous imaging, particularly in anatomically confined regions such as the dorsum of the hand. Thus, adjunctive diagnostic tools are needed to supplement clinical judgment and identify patients who will benefit from early surgical interventions.

Patient concerns: A 55-year-old female patient presented with extensive swelling and pain in the left hand following contrast medium extravasation during a computed tomography angiography. The initial physical examination revealed minimal skin changes; however, the patient reported progressive pain and taut swelling.

Diagnosis: The examination results were inconclusive of compartment syndrome. Transcutaneous oxygen pressure (TcPO₂) monitoring revealed critically low perfusion values (5 mm Hg in the dorsal wrist and 1 mm Hg in the distal dorsum), suggesting evolving ischemia. Forward-looking infrared thermal imaging confirmed localized hypoperfusion.

Interventions: Based on TcPO₂ and thermal imaging findings, a prophylactic fasciotomy was performed. Negative pressure wound therapy was applied, and primary wound closure was performed on postoperative day 3 without the need for skin grafting.

Outcomes: The patient recovered without wound-related complications, and no additional procedures were required.

Lessons: This may be the first reported case of contrast medium extravasation injury in the hand managed with TcPO₂-guided fasciotomy. TcPO₂ and forward-looking infrared thermography may serve as alternative noninvasive tools to support early decision-making for fasciotomy in cases where traditional clinical signs are absent. Early intervention based on perfusion metrics may prevent irreversible ischemic complications.