• Logo
  • SBMUJournals

Successful Treatment of Digital Ischemia Following Carbon Dioxide Laser and Tourniquet for Digital Procedure with Adjuvant Low Level Laser therapy

Suparuj Lueangarun, Therdpong Tempark




A digital tourniquet with/without epinephrine is commonly used in local anesthetics when operating on digits. However, such a complication as digital ischemia could occur following tourniquet application. We reported an elderly patient with atherosclerotic risk factors and she subsequently underwent a digital tourniquet, partial nail plate removal, and a carbon dioxide laser treatment for subungual wart with digital gangrene development. The successful treatment consisted of wound-dressing, medication, and adjuvant low-level light therapy (LLLT) to enhance the wound healing process, thereby resulting in almost complete recovery of skin color and function of the digit in 3 months. In conclusion, the digital tourniquet should be cautiously applied, especially in elderly patients with atherothrombosis, under minimal pressure and appropriate length of time. Moreover, LLLT could be an effective adjuvant treatment to prevent the vascular complications of the digit.


Digital ischemia; Finger tourniquet; Low-level light therapy; Phalangeal surgery


Tucker S, Harris PC. The unforgettable finger tourniquet. Injury. 2002;33(1):76-77.

Avci P, Gupta A, Sadasivam M, et al. Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. Semin Cutan Med Surg. 2013;32(1):41-52.

Tchanque-Fossuo CN, Ho D, Dahle SE, et al. A systematic review of low-level light therapy for treatment of diabetic foot ulcer. Wound Repair Regen. 2016;24(2):418-426. doi:10.1111/wrr.12399

Becerro de Bengoa Vallejo R, Losa Iglesias ME, Lopez DL, et al. Effects of digital tourniquet ischemia: a single center study. Dermatol Surg. 2013;39(4):584-592. doi:10.1111/

Kam PC, Kavanagh R, Yoong FF. The arterial tourniquet: pathophysiological consequences and anaesthetic implications. Anaesthesia. 2001;56(6):534-545.

Pedowitz RA. Tourniquet-induced neuromuscular injury. A recent review of rabbit and clinical experiments. Acta Orthop Scand Suppl. 1991;245:1-33.

Karu T. Primary and secondary mechanisms of action of visible to near-IR radiation on cells. J Photochem Photobiol B. 1999;49(1):1-17. doi:10.1016/S1011-1344(98)00219-X

Corazza AV, Jorge J, Kurachi C, Bagnato VS. Photobiomodulation on the angiogenesis of skin wounds in rats using different light sources. Photomed Laser Surg. 2007;25(2):102-106. doi:10.1089/pho.2006.2011

Kipshidze N, Nikolaychik V, Keelan MH, et al. Low-power helium: neon laser irradiation enhances production of vascular endothelial growth factor and promotes growth of endothelial cells in vitro. Lasers Surg Med. 2001;28(4):355-364. doi:10.1002/lsm.1062

Barolet D. Light-emitting diodes (LEDs) in dermatology. Semin Cutan Med Surg. 2008;27(4):227-238. doi:10.1016/j. sder.2008.08.003

Russell BA, Kellett N, Reilly LR. A study to determine the efficacy of combination LED light therapy (633 nm and 830 nm) in facial skin rejuvenation. J Cosmet Laser Ther. 2005;7(3-4):196-200. doi:10.1080/14764170500370059

Park KY, Han TY, Kim IS, Yeo IK, Kim BJ, Kim MN. The Effects of 830 nm Light-Emitting Diode Therapy on Acute Herpes Zoster Ophthalmicus: A Pilot Study. Ann Dermatol. 2013;25(2):163-167. doi:10.5021/ad.2013.25.2.163

Caetano KS, Frade MA, Minatel DG, Santana LA, Enwemeka CS. Phototherapy improves healing of chronic venous ulcers. Photomed Laser Surg. 2009;27(1):111-118. doi:10.1089/pho.2008.2398

Park YJ, Kim SJ, Song HS, et al. Prevention of Thyroidectomy Scars in Asian Adults With Low-Level Light Therapy. Dermatol Surg. 2016;42(4):526-534. doi:10.1097/ DSS.0000000000000680

Sadick N. A study to determine the effect of combination blue (415 nm) and near-infrared (830 nm) lightemitting diode (LED) therapy for moderate acne vulgaris. J Cosmet Laser Ther. 2009;11(2):125-128. doi:10.1080/14764170902777349

DOI: https://doi.org/10.22037/jlms.v10i3.22474