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We read with interest this article but would disagree with the authors' comments on acute blue finger being a ‘benign’ condition without threat to limb or digit loss and that arterial imaging studies, therefore, are unnecessary. It has been our experience that the acute blue finger not infrequently progresses to an acute black hand with subsequent digit/limb loss.
We have recently seen a patient who presented with acute blue discolouration of all the finger tips of her left hand with associated pain. She had a completely normal arterial examination, blood tests (including rheumatological and immunological), cardiac investigations and radiographs. Initial angiography was reported as normal. She underwent a left cervical sympathectomy for symptom control but returned a month later with pre-gangrenous changes to the fingertips and intractable pain. Repeat angiography revealed a stenosis at the origin of the left subclavian artery necessitating an endarterectomy. Four months later, after the finger tips had demarcated, all four distal phalanges were amputated with good functional results.
We, therefore, suggest that acute blue finger should not be viewed as a benign condition and warrants full investigation as it may be a prelude to major arterial embolisation.
COMMENT ON doi 10.1308/003588408X318237 R Cowen, T Richards, A Dharmadasa, A Handa, JMT Perkins. The acute blue finger: management and outcome. Ann R Coll Surg Engl 2008; 90: 557–60