Vascular- Ray amputation for traumatic/ischemic finger ulceration with osteomyelitis distal to renal failure dialysis fistula

Description: Hand ischemia in renal failure can be exacerbated by vascular steal effect distal to a dialysis fistula. In this patient, a trivial finger trauma led to a non healing wound which progressed to osteomyelitis deep to the wound. Infected open wounds involving the hands of dialysis patients usually require excision - which often means amputation - to control infection. Amputation is a reasonable primary treatment for this problem when the situation is complicated by diabetes, vascular steal, or transplant related immunosuppression.