Autologous Platelet-rich Plasma in the Conservative Management of a Traumatic Foot Injury with Impending Gangrene in a Pregnant Patient: A Case Report

Musculoskeletal trauma during pregnancy presents a dual challenge, as both the maternal management and foetal safety should be balanced together. This condition presents a challenge in the use of ionising imaging, anaesthesia and operative fixation. Autologous Platelet-Rich Plasma (PRP) can present as a better alternative for wound management in these conditions. This is a case of a 34-year-old female with 31-week gestation presented to the casualty department for the management of an incomplete traumatic amputation of the little toe of the left foot and a laceration over the dorsum. The distal part of the toe was dusky and poorly perfused, consistent with impending gangrene. Radiographical assessment (abdominal lead-apron shielding) showed a comminute fracture of the head of the fifth metatarsal and a fracture of the distal phalanx of the fifth toe.The wound was cleaned, debrided, with stay sutures placement followed by the initiation of the autologous PRP therapy. The initially non-viable-appearing wound demarcated and granulated over the PRP course, and the toe was salvaged; the wound subsequently healed completely by secondary intention under topical recombinant human epidermal growth factor and mupirocin dressings. She delivered a healthy female neonate at term. Follow-up at one year showed a gradual foot healing and weight-bearing. Autologous PRP combined with meticulous wound care might be associated with salvage of a devascularised digit with impending gangrene in pregnant females with non-feasibility of operative fixation. Hence, it can be recommended as a low-risk adjunct for wound healing in pregnant patients with limited surgical options.