In an attempt to evaluate the factors that result in upper-extremity digital amputation secondary to acute non-traumatic ischemia, nine patients with digital amputations secondary to septic or non-septic emboli were evaluated retrospectively. Although some evidence was present in three patients, no primary focus of emboli could be confirmed in six cases. All patients were consulted about hand surgery > or = 7 days following the clinical suspicion of ischemia for different reasons. No patient had cardiac disease that might result in emboli. The most important factor that resulted in unfavorable prognosis was unknown or unproven primary focus of the emboli, including septic emboli. As a consequence, delay in recognition of the ischemia affects the outcome. Age, gender, and health condition before the incidence did not affect the outcome. Health condition of the patient at the time of diagnosis affects the outcome, as life-threatening conditions change the focus of attention and result in late recognition of the ischemia. Upper-extremity digital ischemia needs a high index of suspicion in cases with unknown or unproven primary focus of the emboli. Prompt recognition and early consultation seem necessary to prevent or reduce the extent of the amputation.