Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Successful local use of heparin calcium for congested fingertip replants

  • Received : 2019.05.27
  • Accepted : 2019.11.23
  • Published : 2020.01.15
Download PDF
⟨ Previous Next ⟩

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.

Keywords

References

  1. Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg 2011;128:723-37. https://doi.org/10.1097/PRS.0b013e318221dc83
  2. Hattori Y, Doi K, Sakamoto S, et al. Fingertip replantation. J Hand Surg Am 2007;32:548-55. https://doi.org/10.1016/j.jhsa.2007.01.019
  3. Hattori Y, Doi K, Ikeda K, et al. Significance of venous anastomosis in fingertip replantation. Plast Reconstr Surg 2003; 111:1151-8. https://doi.org/10.1097/01.PRS.0000046497.88549.E0
  4. Ito H, Sasaki K, Morioka K, et al. Fingertip amputation salvage on arterial anastomosis alone: an investigation of its limitations. Ann Plast Surg 2010;65:302-5. https://doi.org/10.1097/SAP.0b013e3181cc0021
  5. Ishikawa K, Kawakatsu M, Arata J, et al. Classification of the amputation level of the distal part of the finger: a 10 years study. J Jpn Soc Surg Hand 2001;18:870-4.
  6. Scheker LR, Becker GW. Distal finger replantation. J Hand Surg Am 2011;36:521-8. https://doi.org/10.1016/j.jhsa.2010.12.017
  7. Hasuo T, Nishi G, Tsuchiya D, et al. Fingertip replantations: importance of venous anastomosis and the clinical results. Hand Surg 2009;14:1-6. https://doi.org/10.1142/S0218810409004177
  8. Zhang X, Wen S, Wang B, et al. Reconstruction of circulation in the fingertip without vein repair in zone I replantation. J Hand Surg Am 2008;33:1597-601. https://doi.org/10.1016/j.jhsa.2008.05.005
  9. Tanaka K, Urata S, Arai T. Relief of congestion by subcutaneous injection of Caprocin after replantation of distal phalanx. J Jpn Soc Reconstr Microsurg 2010;23:263-9.
  10. Yokoyama T, Hosaka Y, Takagi S. The place of chemical leeching with heparin in digital replantation: subcutaneous calcium heparin for patients not treatable with systemic heparin. Plast Reconstr Surg 2007;119:1284-93. https://doi.org/10.1097/01.prs.0000254496.02314.3e
  11. Patradul A, Ngarmukos C, Parkpian V. Distal digital replantations and revascularizations. 237 digits in 192 patients. J Hand Surg Br 1998;23:578-82. https://doi.org/10.1016/S0266-7681(98)80005-3
  12. Han SK, Lee BI, Kim WK. Topical and systemic anticoagulation in the treatment of absent or compromised venous outflow in replanted fingertips. J Hand Surg Am 2000;25:659-67. https://doi.org/10.1053/jhsu.2000.6920
  13. Kamei K, Sinokawa Y, Kishibe M. The venocutaneous fistula: a new technique for reducing venous congestion in replanted fingertips. Plast Reconstr Surg 1997;99:1771-4. https://doi.org/10.1097/00006534-199705010-00050
  14. Buntic RF, Brooks D. Standardized protocol for artery-only fingertip replantation. J Hand Surg Am 2010;35:1491-6. https://doi.org/10.1016/j.jhsa.2010.06.004
  15. Ishikawa K, Ogawa Y, Soeda H, et al. A new classification of the amputation level for the distal part of the fingers. J Jpn Soc Reconstr Microsurg 1990;3:54-62.
  16. Koshima I, Yamashita S, Sugiyama N, et al. Successful delayed venous drainage in 16 consecutive distal phalangeal replantations. Plast Reconstr Surg 2005;115:149-54. https://doi.org/10.1097/01.prs.0000146869.92997.f3

Cited by

  1. Effects of hyperbaric oxygen on graft survival outcomes in composite grafting for amputated fingertip injury vol.47, pp.5, 2020, https://doi.org/10.5999/aps.2020.00381
  2. Analysis of Outcomes of Tamai Zone I Digital Replantation in Cases of Severe Crushing Injury vol.25, pp.4, 2020, https://doi.org/10.12790/ahm.20.0057
  3. Postoperative Digit and Hand Replantation Protocols: A Review of the Literature vol.29, pp.15, 2020, https://doi.org/10.5435/jaaos-d-20-01176
  4. Spare Parts Surgery with a Free Posterior Interosseous Artery Perforator Flap for Thumb Tip vol.9, pp.6, 2020, https://doi.org/10.1097/gox.0000000000003624