Promethazine is a commonly used medication to treat nausea and motion sickness. Case reports have recently surfaced on the dangers of parenteral administration of promethazine. We present a case report of a presumed intravenous injection of promethazine into an antecubital intravenous line resulting in necrosis of the ring finger distal to the DIP joint and hypoperfusion of the digits. Peripheral sympathectomy was performed to improve nutritional flow and improve ischemic pain. However, although this novel treatment option was successful, ultimately the patient had an amputation of her ring finger at the level of her middle phalanx. Although no proven successful treatment exists, the updated treatment options following inadvertent intra-arterial or perivascular administration are presented. Given the limited success of current treatment options for intra-arterial or perivascular extravasation, the staggering medical malpractice awards in such cases, and the numerous therapeutic alternatives to promethazine, the medical community should question the safety and continued administration of promethazine by an intravenous route.

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In cases of recalcitrant carpal tunnel syndrome, many surgical procedures have been described to provide a healthy tissue bed to the median nerve, including hypothenar fat pad flaps (Strickland et al., 1996), reverse radial artery adipofascial flaps (Braun et al., 1995), pronator quadratus muscle flaps (Dautel and Merle, 1993) and abductor digiti minimi flaps (Reismann and Dellon, 1983). We report a case of the successful treatment of recalcitrant carpal tunnel syndrome by an adipofascial flap based on an ulnar artery perforator, when the intended radial artery perforator was unavailable.A 55-year old right-hand dominant woman presented with carpal tunnel syndrome in the right hand with an associated palmar wrist ganglion. Nerve conduction studies confirmed median nerve compression at the carpal tunnel on the right side. She underwent an open carpal tunnel decompression and excision of the ganglion. She then developed similar symptoms of carpal tunnel syndrome on the left hand that was treated by open decompression a few months later. After successful resolution of her symptoms, she was discharged at the 3-month follow-up.She re-presented 6 months later with recurrence of left sided carpal tunnel syndrome and an extremely hypersensitive scar .She underwent a further decompression along with an adipofascial forearm flap based on a radial artery perforator, preserving the radial artery (Braun et al., 1995). The patient had complete resolution of symptoms on the left side, but she complained of a persistent tender scar and recurrence of median nerve symptoms on the right side. It was planned to carry out a similar adipofascial flap based