Arch Hand Microsurg 2019; 24(4): 345-350  
Epinephrine-Induced Digital Vasospasm Reversed by a Phentolamine-Papaverine-Alprostadil Complex: A Case Report
Sung Hoon Koh, Youngkee You, Jin Soo Kim, Dong Chul Lee, Si Young Roh, Kyung Jin Lee, Min Ki Hong
Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
Correspondence to: Jin Soo Kim
Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital, 36 Digital-ro, Gwangmyeong 14241, Korea
TEL: +82-2-2680-7637, FAX: +82-2-2615-7218, E-mail: drkim@korea.com, ORCID: https://orcid.org/0000-0003-3369-2974
Received: August 1, 2019; Revised: September 18, 2019; Accepted: September 22, 2019; Published online: December 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Epinephrine is widely used to treat severe anaphylaxis. However, the accidental injection of epinephrine into regions containing terminal arteries, such as digits, may cause severe vasospasm, leading to digital ischemia, deepithelialization, wound infection, and potential necrosis. To reverse such epinephrine-induced digital ischemia, phentolamine acts as an antagonist of epinephrine by blocking alpha-receptors. However, since a pure phentolamine drug was not readily available at our hospital, we used Standro (a phentolamine-papaverine-alprostadil complex) as an alternative. Profound ischemia in a patient who accidentally injected epinephrine into her right thumb was promptly reversed after the direct drop of Standro on the puncture site. The wound healed completely after 1 week, without any remarkable sequelae. This case study supports the use of the phentolamine complex for the rapid and safe reversal of epinephrine-induced digital ischemia.
Keywords: Vasoconstriction, Fingers, Ischemia, Epinephrine, Phentolamine


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