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J Hand Microsurg 2017; 09(03): 159-162
DOI: 10.1055/s-0037-1608694
Case Report
Thieme Medical and Scientific Publishers Private Ltd.

Neurogenic Edema from Complex Regional Pain Syndrome Resulting in Fulminant Infection Necessitating Below Elbow Amputation

Daniel P. Carpenter
1   Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
,
Reid W. Draeger
1   Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
› Author Affiliations
Further Information

Publication History

22 July 2017

28 August 2017

Publication Date:
29 November 2017 (online)

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Abstract

We report a case of severe upper extremity complex regional pain syndrome type 1 (CRPS-1) and neurogenic edema that ultimately led to a medically necessary below-elbow amputation. The patient presented with a history of remote bilateral carpal tunnel release complicated by debilitating and recalcitrant bilateral CRPS-1. Following years of severe neurogenic edema of the left upper extremity, the patient had full-thickness skin sloughing on the dorsum of her hand due to massive edema. This subsequently led to maggot infestation of the soft tissues of the left hand ultimately necessitating amputation. We present the case as an illustration of an extreme case of neurogenic edema, a potential physical manifestation of CRPS-1. The case presented discusses upper extremity amputation as an end treatment option for CRPS-1, though in this case amputation was primarily indicated secondary to medical necessity.

Keywords

amputation - carpal tunnel syndrome - complex regional pain syndrome - infection - neurogenic edema
 

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