764 Acute Ischaemic Hand Following Intra-Arterial Injection into Ulnar Artery

Introduction Intra-arterial drug injuries, although rare, have increased in number in the last decade due to the prevalence of intravenous drug use. Despite this and their potentially serious consequences, there are no standard guidelines on how to manage these injuries. We report a rare case of acute hand ischaemia following intra-arterial drug injection. Clinical case: A 29-year-old male presented to the emergency department with pain and swelling of his right hand and forearm, following injection of crushed cyclizine tablets into his right antecubital fossa the day before. Clinically he had signs of compartment syndrome and an acute ischaemic hand. He underwent emergency fasciotomies of his right forearm. Intra-operatively, his ulnar artery was found to be thrombosed and an embolectomy retrieved a 15cm occlusive thrombus. However, there was no change in hand perfusion following this and the patient was started on therapeutic anticoagulation. Post-operatively, he developed necrosis of his right hand. Part of his thumb and index finger were viable and preserved to maintain pincer grip. He underwent staged debridement and resurfacing of his right hand with a pedicled groin flap. Conclusions Intra-arterial drug injuries are uncommon but serious injuries and should be considered in any patient with a history of intravenous drug use presenting with severe limb pain. Admission for 24 hours of close observation may be warranted as ischaemia may only occur 24-48 hours after the injury. In patients with ischaemia, anticoagulation may be considered. Our patient presented with signs of compartment syndrome requiring fasciotomies and staged debridement prior to definitive reconstruction.