title: Postoperative care in finger replantation: our case-load and review of the literature.
abstract: OBJECTIVE
  Technical success of a finger replantation depends on several factors such as surgical procedure, type of injury, number of segments amputated, amputation level and individual patient factors. Among early complications that can occur in this type of surgery the onset of venous or arterial thrombosis is the most dreaded. Local irrigating solutions, oral and intravenous anticoagulants, thrombolytic agents, plasma expanders, vasodilating, and antiaggregant drugs are routinely used in patients undergoing microvascular procedures, but currently there is only a non-standardized practice based on anecdotal personal experience.
  
  
  METHODS
  The aim of our study is to review selected literature relating to perioperative therapy in microsurgical digital replantation. We also report our case-load of 16 patients with finger avulsion describing our particular protocol for postoperative anticoagulation and restoration of fluid and electrolyte balance.
  
  
  RESULTS
  Following our daily pharmacological protocol, the postoperative course of the replanted fingers was uneventful. The survival rate for finger replantations performed was 100% (n = 16) with no need for surgical revisions.
  
  
  CONCLUSIONS
  The association Dextran-40/Heparin/fluids in the proposed standardized pro-weight pharmacological protocol is an optimal postoperative prophylactic/therapeutic plan to reduce the incidence of endovascular thrombosis after replantation, so ensuring high rate of success in microvascular surgery.
authors.affiliation: Unit of Plastic and Reconstructive Surgery, Department of Surgery, "Sapienza" University of Rome, Rome, Italy. federicolotorto@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Cigna
authors.forename: F
authors.initials: F
authors.lastname: Lo Torto
authors.forename: M
authors.initials: M
authors.lastname: Maruccia
authors.forename: M
authors.initials: M
authors.lastname: Ruggieri
authors.forename: F
authors.initials: F
authors.lastname: Zaccheddu
authors.forename: H C
authors.initials: HC
authors.lastname: Chen
authors.forename: D
authors.initials: D
authors.lastname: Ribuffo
mesh_terms: D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005383:Finger Injuries / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D005385:Fingers / Q000098:blood supply / Q000601:surgery; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012092:Replantation / Q000379:methods*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin