Successful local use of heparin calcium for congested fingertip replants

Abstract

Background Conventional methods of external bleeding for congested fingertip replants exhibit notable problems, including uncontrollable bleeding and unpredictable survival of the replant. We have added a local injection of heparin calcium to the routine use of systemic heparinization for inducing external bleeding. We retrospectively examined patients who underwent external bleeding using our method. Methods Local subcutaneous injections of heparin calcium were made in 15 congested replants in addition to systemic heparinization. Each injection ranged from 500 to 5,000 U. The average duration of the injections was 4.1 days. Surgical outcomes were analyzed and compared with a control group of patients who underwent external bleeding without heparin calcium. Results The overall survival rate was 93.3%, which was higher than that of the control group (83.3%), but the difference was not statistically significant (P = 0.569). The survival rate for subzones I and II by the Ishikawa subzone classification was 100%, whereas it was 87.5% in subzones III and IV. No statistically significant difference was observed. The rate of partial necrosis was 0% in subzones I and II, whereas it was significantly higher (66.7%) in subzones III and IV (P = 0.015). The mean total blood loss via external bleeding was 588 g in 10 fingers. No patients required blood transfusion. Conclusions Congestion of a replanted fingertip can be successfully managed without blood transfusion by our method. Although complete relief from congestion in replants in subzones I and II is achievable, there is a higher risk of partial necrosis in subzones III and IV.

Spare Parts Surgery with a Free Posterior Interosseous Artery Perforator Flap for Thumb Tip

“… 3 Successful replantation gives the satisfactory results of both function and appearance of the fingertips. Although highly successful rates are reported frequently, 4 in some cases, the sites could progress to necrosis and require reconstructive surgery later. Despite many reports, when the nail matrix is found to be preserved with defects in the bone or nail bed, simply covering the stump with flaps will give the fingertips deformities and shorter finger length, resulting in poor satisfaction.…”

Postoperative Digit and Hand Replantation Protocols: A Review of the Literature

“…Success rates range between 64% and 100%, but topical anticoagulation may be associated with increased blood transfusion requirement (average four units transfused in approximately 50% of patients), partial necrosis in more proximal fingertip zone injuries, and prolonged hospital stay (7-day average, range 5 to 10 days). 32,37,38 Controlled fingertip bleeding is an alternative to leech therapy. 33 A retrospective review was done to determine the efficacy of a controlled external bleeding protocol (24 fingertip replantations in 22 patients; level IV).…”

“…Success rates range between 64% and 100%, but topical anticoagulation may be associated with increased blood transfusion requirement (average four units transfused in approximately 50% of patients), partial necrosis in more proximal fingertip zone injuries, and prolonged hospital stay (7-day average, range 5 to 10 days). 32,37,38…”

50+ years of replantation surgery experience: are we progressing or regressing?

“…In addition to dose, one study found increased survival with progressive weaning of heparin rather than abruptly discontinuing it [40] . While systematic heparinization does not appear to impact success rates, two recent studies have supported digit salvage using local injections of heparin [41] or heparin calcium [42] . Preventing complications with arterial inflow and venous outflow is critical for obvious reasons and also because even if caught early salvage rates remain low [43] .…”