title: [Loss of the replanted thumb by drug-induced ergotism].
abstract: Vasospastic reactions are known to be a complication of thromboembolic prophylaxis with Heparin-dihydroergotamine. We describe a rare case after successful replantation of an amputated thumb. On the third day after surgery, Heparin-dihydroergotamine was administered once. Within three hours, the thumb turned pale and cold. At revision, a spasm of the artery proved to be the cause of ischemia. Therapeutic efforts were unsuccessful, even intraarterial injection of Prostaglandin E1 and the interposition of a vein graft. Amputation became necessary. Because of the possible complication with ergotism and the consequence of a failed replantation, we suggest not to use Heparin-dihydroergotamine for thromboembolic prophylaxis in microsurgery.
authors.affiliation: Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie am Krankenhaus der Barmherzigen Brüder, Regensburg.
authors.forename: C
authors.initials: C
authors.lastname: Coppeneur-Krieger
authors.forename: E B
authors.initials: EB
authors.lastname: Plock
authors.forename: R
authors.initials: R
authors.lastname: Neugebauer
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D000673:Amputation, Traumatic / Q000601:surgery*; D004087:Dihydroergotamine / Q000008:administration & dosage / Q000009:adverse effects*; D004338:Drug Combinations; D004881:Ergotism / Q000601:surgery*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007511:Ischemia / Q000139:chemically induced / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000139:chemically induced* / Q000601:surgery; D012086:Reoperation; D012092:Replantation; D013933:Thumb / Q000098:blood supply / Q000293:injuries* / Q000601:surgery
chemical_list: D004338:Drug Combinations; D006495:Heparin, Low-Molecular-Weight; C031388:heparin-dihydergot; D004087:Dihydroergotamine
vernacular_title: Verlust des replantierten Daumens durch medikamentös verursachten Ergotismus.