[Addition of antithrombosis in situ in the case of digital replantation: preliminary prospective study of 13 cases].
Antithrombotic agents are not routinely used in microsurgery for finger replantation. A prospective monocentric study of 13 cases of replantation at hand level is reported with local irrigation of anastomosis with urokinase and low-molecular-weight heparin. Thirteen consecutive patients have been included and treated in the first six hours by three senior surgeons in microsurgery. The injuries consisted in one devascularisation of hand, two complete amputations of hand, four ring fingers and six complete amputations of finger. Crush injury was always pointed in case of amputation. During anastomoses, the arterial lumina were topically irrigated with 50,000 UI of urokinase and the venous lumina by 1.2 ml of Lovenox®. Bleeding was encouraged in case of digit replantation. In all cases, patients received Aspegic® 10mg/day and Fonzylane® three times per day for three weeks. Three failures have been reported and blood transfusion was necessary in one patient. The results showed that topical irrigation with urokinase and low-molecular-weight heparin or enoxaparin solution significantly reduced the thrombosis rate at the anastomosis site of the crushed arteries in clinical practice without uncontrolled adverse effect.
Loisel
F
F
Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, EA 4268 innovation, imagerie, ingénierie et intervention en santé I4S-IFR 133 Inserm, CHU Jean-Minjoz, université de Franche-Comté, Besançon, France. francois_loisel@yahoo.fr
Pauchot
J
J
Gasse
N
N
Meresse
T
T
Rochet
S
S
Tropet
Y
Y
Obert
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic; D000714:Anastomosis, Surgical; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage / Q000031:analogs & derivatives; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008239:Lysine / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D011759:Pyrrolidines / Q000008:administration & dosage; D019651:Plastic Surgery Procedures / Q000379:methods; D012092:Replantation / Q000379:methods*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage; D014665:Vasodilator Agents / Q000008:administration & dosage
D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D011759:Pyrrolidines; D014665:Vasodilator Agents; D014568:Urokinase-Type Plasminogen Activator; D008239:Lysine; D001241:Aspirin; C010651:buflomedil; C010395:acetylsalicylic acid lysinate