Background: The purpose of this study was to clarify the appropriate use of unfractionated heparin as an anticoagulation agent after digital replantation. Methods: This study was a prospective, randomized, single-blind, blinded-endpoint method, three-arm, parallel-group, controlled clinical trial conducted at a single institution. A total of 88 patients (101 fingers) following digital amputation and subsequent repair by anastomosis of both arteries and veins were randomly allocated into three groups: (1) control group (no heparin dose), (2) low-dose heparin group (10,000 IU/day), and (3) high-dose heparin group (start at 15,000 IU/day, then adjust the dose to achieve an activated partial thromboplastin time of 1.5 to 2.5 times the baseline). The outcomes were assessed regarding the proportion of success at 2 weeks after replantation of amputated digits, total or partial necrosis, and occurrence of complications. Results: No significant differences were found among the three groups, except for complications of congestion. The odds ratio of the heparin group compared with the control group for a success proportion was 5.40 (95 percent CI, 0.85 to 34.20; p = 0.027) in subjects aged 50 years or older. Significant elevations of activated partial thromboplastin time, aspartate transaminase, and alanine aminotransferase occurred in high-dose heparin groups on day 7. Conclusion: Unfractionated heparin administration is considered effective for patients aged 50 years or older, although the routine use of unfractionated heparin is not necessary after digital replantation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
Background:The eyelid structure can be divided into an inner layer and an outer layer. Reconstruction of a full-thickness eyelid defect is accomplished by full-thickness composite tissue transfer or combined layered reconstruction. We present a new technique for inner layer reconstruction using ear cartilage and oral mucosa.Methods:The oral mucosa graft is harvested from the inner side of the lower lip to fit the defect size and shape. The ear cartilage graft is harvested as a rectangular strip. The harvested mucosa is sutured to the defect margin and the cartilage strip graft is interposed to the defect. Finally, the outer layer of the defect is covered with skin flaps. Consequently, the ear cartilage graft is sandwiched between the mucosa graft and the skin flap.Results:We used this technique for the reconstruction of 13 full-thickness eyelid defects of various locations, sizes, and shapes. Ten cases involved the lower eyelid, 2 cases involved the lower eyelid including the medial canthus, and 1 case involved the upper eyelid. The oral mucosa graft survived in all patients. The reconstructions were successful and there were no postoperative reports of conjunctival or corneal irritation.Conclusions:The present technique using a combination of an ear cartilage strip graft and oral mucosa graft is an easy and versatile technique for reconstruction of inner layer eyelid defects. We believe that the beneficial effects of tears, which are richly oxygenated, improved survival of the grafted mucosa.
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