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Polycythemia as an Underlying Cause of Digital Gangrene: A Rare and Unusual Case Presentation

Peter N. Ly VA Central California Health Care System, Surgical Service 112, Fresno, CA.

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Digital gangrene is frequently encountered in patients who have diabetes with peripheral vascular compromise, with or without superimposed infection. Preoperative laboratory values and radiographic images are important to determine a proper course of action. Equally important is a thorough history taking to confirm or rule out systemic entities and preexisting conditions that can aggravate or predispose one to the development of digital gangrene. A patient with diabetes presented with a rare and unusual case of digital gangrene, as he clinically had strong pedal pulses. Preoperative workup revealed a suspicion of polycythemia, which was subsequently confirmed. The patient underwent several days of phlebotomy until his hemoglobin and hematocrit levels were brought down to optimized levels before a digital amputation was performed. He went on to heal uneventfully, and he is currently being closely followed by oncology/hematology colleagues with periodic phlebotomy.

Corresponding author: Peter N. Ly, DPM, VA Central California Health Care System, Surgical Service 112, 2615 E Clinton Ave, Fresno, CA 93703-2286. (E-mail: peter.ly@va.gov)