Hand Trauma

Hand Trauma


Anticoagulation Following Digital Replantation


Buckley T, Hammert WC (Univ of Rochester Med Ctr, NY) J Hand Surg 36A:1374-1376, 2011§



A. Chong, MD



Evidence Ranking


• C



Expert Rating


• 2



Abstract



Background


Replanting amputated digits is associated with success rates as high as 90%. The most common complications are venous insufficiency and arterial thrombosis. Artery-only replantation has reasonable success, but can be complicated by arterial thrombi, 90% of which occur in the first 24 hours, or venous thrombosis, 42% of which occurs after the first 24 hours. Surgeons vary widely concerning methods of systemic anticoagulation and duration of therapy. Aspirin, intravenous (IV) heparin, low-molecular-weight heparin (LMWH), IV dextran, and local heparin through direct injection or continuous drip on an open incision are all methods currently used to achieve anticoagulation.



Case Report


Man, 28, sustained a guillotine-type amputation of his left index and middle fingers through the middle phalanx while preparing food. The digits were wrapped in gauze immediately, stored on ice in a plastic bag, and taken to the emergency room with the patient within an hour of the injury. Replantation was attempted.



Assessment of Anticoagulation Methods

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Apr 2, 2016 | Posted by in Hand surgery | Comments Off on Hand Trauma

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